TY - JOUR
T1 - Liver involvement in children with SARS-COV-2 infection
T2 - Two distinct clinical phenotypes caused by the same virus
AU - Perez, Adriana
AU - Cantor, Amanda
AU - Rudolph, Bryan
AU - Miller, Jonathan
AU - Kogan-Liberman, Debora
AU - Gao, Qi
AU - Da Silva, Bernardo
AU - Margolis, Kara G.
AU - Ovchinsky, Nadia
AU - Martinez, Mercedes
N1 - Funding Information:
This work was supported in part by the National Center for Advancing Translational Sciences (NCATS), components of the National Institutes of Health (NIH), through CTSA grant numbers UL1TR001073 (AR/BR) and KL2TR001071 (BR). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. This work is also supported by the Einstein‐Mount Sinai Diabetes Research Center NIH‐5P60DK20541 (BR). Drs Gross‐Margolis and Miller receive support via NIH T32DK083256 (JM), NIH RO1NS01554 (KGM), and DoDPR160365 (KGM).
Funding Information:
s This work was supported in part by the National Center for Advancing Translational Sciences (NCATS), components of the National Institutes of Health (NIH), through CTSA grant numbers UL1TR001073 (AR/BR) and KL2TR001071 (BR). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. This work is also supported by the Einstein-Mount Sinai Diabetes Research Center NIH-5P60DK20541 (BR). Drs Gross-Margolis and Miller receive support via NIH T32DK083256 (JM), NIH RO1NS01554 (KGM), and DoDPR160365 (KGM).
Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2021/9
Y1 - 2021/9
N2 - Background and Aims: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) associated acute liver injury (ALI) has been linked to poor outcomes in adults. Here we compare characteristics in children with elevated ALT (E-ALT) in two distinct manifestations of the infection, multisystem inflammatory syndrome-children (MIS-C) and coronavirus disease 2019 (COVID-19). Methods: This is a retrospective study of patients ≤21 years of age with positive for SARS-CoV-2 PCR. E-ALT was defined as alanine aminotransferase (ALT) > 40 U/L. Bivariate analysis and multivariable logistic regression were obtained to describe differences in children with and without E-ALT in COVID-19 and MIS-C. Results: E-ALT was detected in 36% of the 291 patients; 31% with COVID-19, and 51% with MIS-C. E-ALT in COVID-19 was associated with obesity (P <.001), immunocompromised status (P =.04), and chronic liver disease (P =.01). In the regression models, E-ALT in COVID-19 was associated with higher c-reactive protein (OR 1.08, P =.01) after adjusting for common independent predictors. Children with E-ALT and MIS-C were more often boys (P =.001), Hispanic (P =.04), or Black (P <.001). In MIS-C, male gender (OR 5.3, P =.02) and Black race (OR 4.4, P =.04) were associated with increased odds of E-ALT. Children with E-ALT in both cohorts had significantly higher multiorgan dysfunction, longer hospitalization, and ICU stay. Children with MIS-C had 2.3-fold increased risk of E-ALT compared to COVID-19. No association was found between E-ALT and mortality. Conclusion: E-ALT with SARS-CoV-2 presents as elevated transaminases without hepatic synthetic dysfunction. Patients with either manifestation of SARS-CoV-2 infection and E-ALT experienced more severe disease.
AB - Background and Aims: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) associated acute liver injury (ALI) has been linked to poor outcomes in adults. Here we compare characteristics in children with elevated ALT (E-ALT) in two distinct manifestations of the infection, multisystem inflammatory syndrome-children (MIS-C) and coronavirus disease 2019 (COVID-19). Methods: This is a retrospective study of patients ≤21 years of age with positive for SARS-CoV-2 PCR. E-ALT was defined as alanine aminotransferase (ALT) > 40 U/L. Bivariate analysis and multivariable logistic regression were obtained to describe differences in children with and without E-ALT in COVID-19 and MIS-C. Results: E-ALT was detected in 36% of the 291 patients; 31% with COVID-19, and 51% with MIS-C. E-ALT in COVID-19 was associated with obesity (P <.001), immunocompromised status (P =.04), and chronic liver disease (P =.01). In the regression models, E-ALT in COVID-19 was associated with higher c-reactive protein (OR 1.08, P =.01) after adjusting for common independent predictors. Children with E-ALT and MIS-C were more often boys (P =.001), Hispanic (P =.04), or Black (P <.001). In MIS-C, male gender (OR 5.3, P =.02) and Black race (OR 4.4, P =.04) were associated with increased odds of E-ALT. Children with E-ALT in both cohorts had significantly higher multiorgan dysfunction, longer hospitalization, and ICU stay. Children with MIS-C had 2.3-fold increased risk of E-ALT compared to COVID-19. No association was found between E-ALT and mortality. Conclusion: E-ALT with SARS-CoV-2 presents as elevated transaminases without hepatic synthetic dysfunction. Patients with either manifestation of SARS-CoV-2 infection and E-ALT experienced more severe disease.
KW - COVID-19 ALI in children
KW - acute liver failure
KW - acute liver injury and MISC
KW - elevated ALT
KW - liver involvement in SARS-CoV2
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U2 - 10.1111/liv.14887
DO - 10.1111/liv.14887
M3 - Article
C2 - 33826804
AN - SCOPUS:85105546877
SN - 1478-3223
VL - 41
SP - 2068
EP - 2075
JO - Liver International
JF - Liver International
IS - 9
ER -
