J Korean Med Sci.  2016 Nov;31(11):1784-1789. 10.3346/jkms.2016.31.11.1784.

Distribution of Diseases Causing Liver Function Test Abnormality in Children and Natural Recovery Time of the Abnormal Liver Function

• Jang M
• Oh MS
• Oh SC
• Kang KS

• KMID: 2470275
• DOI: http://doi.org/10.3346/jkms.2016.31.11.1784

Abstract

Although liver function test abnormality is frequently noted in children, there is no report about the distribution of the etiology and natural recovery time of the abnormal liver function. From March 2005 to February 2014, clinical information was retrospectively collected from 559 children who had abnormal liver function and were hospitalized or visited the outpatient clinic at the Jeju National University Hospital. The etiology of abnormal liver function was classified into groups and the natural recovery time of abnormal liver function was analyzed. The etiological groups of 559 patients included 'nonspecific hepatitis' in 42 (7.5%), 'infection' in 323 (57.8%), 'rheumatologic and autoimmune' in 66 (11.8%), 'nonalcoholic fatty liver disease' in 57 (10.2%), 'anatomic' in 12 (2.1%), 'toxic' in 13 (2.1%), 'metabolic' in 8 (1.4%), 'hematologic' in 7 (1.3%), 'hemodynamic' in 4 (0.7%), and 'others' in 27 (4.8%). Among the 'infection' group (57.8%), the 'viral infection in the respiratory tract' subgroup, which had 111 patients (19.8%), was the most common. The natural recovery time of the abnormal liver function was 27 days (median) in 'nonspecific hepatitis', 13 days (median) in 'viral respiratory tract disease', 16 days (median) in 'viral gastroenteritis', 42 days (median) in 'viral febrile illness", and 7 days (median) in "Kawasaki disease". The information on the natural recovery time of abnormal liver function may help the physician to perform good clinical consultation for patients and their parents.

Keyword

Liver Function Test; Children; Recovery

MeSH Terms

Adolescent
Alanine Transaminase/analysis
Aspartate Aminotransferases/analysis
Child
Child, Preschool
Female
Hospitalization
Humans
Infant
Liver Diseases/*etiology
Liver Function Tests
Male
Recovery of Function
Retrospective Studies
Time Factors
Virus Diseases/diagnosis

Figure

• 

  Fig. 1 The distribution of the etiologic disease groups causing abnormal liver test in 559 children. The ‘Infection’ group was the most common, followed by ‘Rheumatologic and autoimmune’, ‘NAFLD’, ‘Nonspecific hepatitis’, ‘Others’, ‘Toxic’, and ‘Anatomic’ groups et cetera.

• 

  Fig. 2 The distribution of the etiologic disease subgroups in the ‘Infection’ group. The ‘Viral infection in the respiratory tract’ subgroup was the most common, followed by ‘viral AGE’, ‘hepatotropic virus infection’, ‘r/o viral febrile illness’, ‘CMV infection’, ‘Other viral infection’, and ‘Nonviral infection subgroups et cetera.

• 

  Fig. 3 Natural recovery time (median) of the abnormal liver function in etiologic disease subgroups, which had transient abnormal liver function test. The natural recovery time was analyzed in the patients of 8 etiological subgroups who completed follow-up until recovery of abnormal liver function. The natural recovery time of 8 etiological subgroups was 27 days (median) ranged from 2 days to 293 days in the ‘nonspecific hepatitis’ subgroup, 29 days (median) ranged from 7 days to 181 days in the ‘CMV infection’ subgroup, 40 days (median) ranged from 13 days to 76 days in the ‘EBV infection’ subgroup, 70 days (median) ranged from 9 days to 71 days in the ‘enterovirus infection’ subgroup, 13 days (median) ranged from 2 days to 238 days in the ‘viral infection in the respiratory tract’ subgroup, 16 days (median) ranged from 2 days to 145 days in the ‘viral AGE’ subgroup, 42 days (median) ranged from 4 days to 335 days in the ‘r/o viral febrile illness’ subgroup, and 7 days (median) ranged from 2 days to 99 days in the ‘Kawasaki disease’ subgroup. CMV = cytomegalovirus, EBV = epstein bar virus, AGE = acute gastroenteritis. *,†,‡Compared to the ‘r/o viral febrile illness’ subgroup: *P = 0.008, †P = 0.020, ‡P = 0.000; §Compared to the ‘nonspecific hepatitis’ subgroup: §P = 0.005 (ANOVA, Post Hoc analysis, Bonferroni).

Reference

1. Kang KS. Abnormality on liver function test. Pediatr Gastroenterol Hepatol Nutr. 2013; 16:225–232.

2. Pratt DS. Liver chemistry and function tests. In : Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders;2010. p. 1227–1238.

3. O’Brien CB. The hospitalized patient with abnormal liver function tests. Clin Liver Dis. 2009; 13:179–192.

4. Astegiano M, Sapone N, Demarchi B, Rossetti S, Bonardi R, Rizzetto M. Laboratory evaluation of the patient with liver disease. Eur Rev Med Pharmacol Sci. 2004; 8:3–9.

5. McKenna JP, Moskovitz M, Cox JL. Abnormal liver function tests in asymptomatic patients. Am Fam Physician. 1989; 39:117–126.

6. Johnson PJ. Role of the standard ‘liver function tests’ in current clinical practice. Ann Clin Biochem. 1989; 26:463–471.

7. Yazigi N, Balistreri WF. Viral hepatitis. In : Kleigman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders;2011. p. 1393–1403.

8. Steigmann F, Szanto PB, Meister HP, Pamukcu F. Clinical significance of nonspecific (reactive) hepatitis. Am J Gastroenterol. 1965; 44:129–137.

9. Schaffner F, Popper H. Nonspecific reactive hepatitis in aged and infirm people. Am J Dig Dis. 1959; 4:389–399.

10. Suriawinata AA, Thung SN. Acute and chronic hepatitis. Semin Diagn Pathol. 2006; 23:132–148.