Liver transaminase concentrations in children with acute SARS-CoV-2 infection

Sumner, Madeleine W; Florin, Todd A.; Kuppermann, Nathan; Xie, Jianling; Tancredi, Daniel J.; Freedman, Stephen B.

doi:10.1016/j.clinbiochem.2023.110588

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…The children were seen at the emergency departments for a respiratory infection. Elevated transaminases were measured in 26% of the COVID‐19 and 22% of the non‐COVID‐19 patients, the difference was not statistically significant (Sumner et al, 2023 ). Another Canadian study compared the incidence of severe liver injury in 4200 hospitalized COVID‐19 patients over the pandemic.…”

Section: Hepatotoxicity Of the Associated Virusesmentioning

confidence: 99%

Non‐A to E hepatitis in children: Detecting a novel viral epidemic during the COVID‐19 pandemic

Brüssow

2023

Microbial Biotechnology

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During the COVID‐19 pandemic, two further novel viral epidemics were described in 2022, monkeypox virus infections in men having sex with men and non‐A to E hepatitis in children. The latter occurred in the first half of 2022 with about 1000 cases worldwide, necessitating liver transplantation in 5% and causing death in 2% of patients. It took some effort to clarify the cause of the novel hepatitis epidemic. Researchers were confronted with a polymicrobial viral infection consisting of an adenovirus‐associated virus type 2 (AAV2) infection, co‐occurring with either human adenovirus type 41 (HAdV41) or herpesvirus infections; most prominently human herpesvirus type 6 (HHV‐6). AAV‐2, a small Dependovirus of the Parvovirus family, needs these helper viruses for its replication. AAV2 is used as a vector for liver‐targeting gene therapy but was not previously known to cause acute hepatitis. HAdV41 and HHV‐6 are mostly known to cause diarrhoea and febrile illnesses associated with skin rashes in children, respectively. Except for a few case reports of HHV‐6 hepatitis, HAdV and HHV‐6 are mostly known as major pathogens in immunosuppressed transplantation patients. A potential role of SARS‐CoV‐2 has also been discussed but the most popular hypothesis involves an indirect role of the COVID‐19 pandemic for this novel disease. Exposure to HHV‐6 infections occurs nearly quantitatively during the first year of life. Social distancing measures, followed by the lifting of these measures in 2022 might have caused a delayed exposure to multiple, normally benign childhood viral infections eliciting a dysregulated immune response with pathological effects for liver cells. In the fall of 2022, when these conditions were not longer met, case numbers dwindled. The hypothesis of an unequilibrated immune response instead of intrinsic cytopathic activity of the implicated viruses is further supported by the enrichment of a particular HLA allele in cases over controls.

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Section: Hepatotoxicity Of the Associated Virusesmentioning

confidence: 99%

Non‐A to E hepatitis in children: Detecting a novel viral epidemic during the COVID‐19 pandemic

Brüssow

2023

Microbial Biotechnology

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“…There is an absence of confirmed findings for relatively rare events such as pediatric liver failure that is not exculpatory of possible linkage. It is also likely that the pathology has shifted over time from when previous studies of viral interaction with the pediatric liver 12,13 were reported which is evidenced by overall decreasing clinical acuity and a rapid decline in Multisystem Inflammatory Syndrome in Children (MIS-C) with different waves of variant infection 14 .…”

Section: Introductionmentioning

confidence: 99%

Older Age and Vaccination Protect Against Transaminase Elevation in Pediatric SARS-CoV2

Ovale,

Charles,

Rosenbaum

et al. 2024

Preprint

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Objectives: SARS-CoV2 infection is reported to induce transaminase elevations. There are case reports of severe liver injury in adult SARS-CoV2 patients, and some have theorized that acute SARS-CoV2 infection may be a driver of severe liver injury in children. While pediatric hepatic injury has previously been described, clear shifts in immunogenic response secondary to prior immune exposure and vaccination since initial reports from 2020 warrant further evaluation. We sought to identify the impact of variant shifts and vaccination on this phenomenon in children. Methods: a retrospective cross sectional study of pediatric SARS-CoV2 patients seen at two hospital facilities in an urban neighborhood in New York City between March 2020 and March 2022 was conducted via chart review. Data was extracted relating to patients demographics, clinical presentation, including the level of care and the laboratory results of comprehensive metabolic panels (CMP). Results: 133 pediatric cases were identified as having SARS-CoV2 and CMP obtained in the same visit. Patients were predominantly Black (79.2%) and non-hispanic (87%) with a mean age of 9.2 years. Risk of transaminase elevation was increased in younger patients and patients with higher level of care. BMI was not a risk factor noted for transaminase elevation. Vaccination decreased degree, not incidence, of transaminase elevation but given low rates of vaccination unable to determine significance of protective efficacy. Conclusions: our study has identified a profound increased risk of transaminase elevation in younger patients, the absence of BMI as a correlating factor in our primarily black patient population, a shift towards non-specific AST elevation with variant windows, and a strong signal of vaccine protection.

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Safety of remdesivir in the treatment of acute SARS-CoV-2 infection in pediatric patients

Player,

Huppler,

Pan

et al. 2024

BMC Infect Dis

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Liver transaminase concentrations in children with acute SARS-CoV-2 infection

Cited by 4 publications

References 11 publications

Non‐A to E hepatitis in children: Detecting a novel viral epidemic during the COVID‐19 pandemic

Non‐A to E hepatitis in children: Detecting a novel viral epidemic during the COVID‐19 pandemic

Older Age and Vaccination Protect Against Transaminase Elevation in Pediatric SARS-CoV2

Safety of remdesivir in the treatment of acute SARS-CoV-2 infection in pediatric patients

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