Elevated serum ALT in children presenting to the emergency unit: Relationship with NAFLD

• Published in: Digestive and liver disease 2009-10, Vol.41 (10), p.749-752
• Main Authors: Nobili, V, Reale, A, Alisi, A, Morino, G, Trenta, I, Pisani, M, Marcellini, M, Raucci, U
• Format: Article
• Language: English
• Subjects: Adolescent; Alanine Transaminase - blood; Child; Child, Preschool; Comorbidity; Emergency room; Emergency Service, Hospital - statistics & numerical data; Fatty Liver - blood; Fatty Liver - diagnosis; Fatty Liver - epidemiology; Fatty Liver - genetics; Fatty Liver - virology; Female; Gastroenterology and Hepatology; Humans; Hypertransaminasemia; Liver - diagnostic imaging; Liver - pathology; Male; NAFLD; NASH; Obesity; Obesity - blood; Obesity - epidemiology; Obesity - pathology; Prevalence; Retrospective Studies; Rome - epidemiology; Ultrasonography
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2009.02.048

Abstract Background Non-alcoholic fatty liver disease, ranging from hepatic steatosis to necro-inflammation with or without fibrosis (non-alcoholic steatohepatitis), is a growing clinical liver disorder in children. Aim The goals of this study were to characterize liver disorders associated with elevated aminotransferases and establish the non-alcoholic fatty liver disease/non-alcoholic steatohepatitis prevalence in hypertransaminasemic children admitted to the emergency room. Methods The medical records of 3280 children (2–17 years of age) admitted to the emergency room of Bambino Gesù Children's Hospital of Rome, and presenting with hypertransaminasemia were analysed retrospectively. Results Elevation of serum alanine aminotransferases was present in 897 patients. Of these, 520 (58%) spontaneously normalized alanine aminotransferases, and 179/897 (20%) maintained persistently elevated alanine aminotransferases levels. Twenty-one patients were excluded because of medication or alcohol use. In the remaining 157 patients with elevated alanine aminotransferases, obesity was found in 87 (55%), viral infections in 52 (33%) and genetic diseases in 14 (9%). Obesity-related alanine aminotransferases elevation was associated with a histological diagnosis of non-alcoholic fatty liver disease in 85% of patients. In particular, steatosis was histologically confirmed in 74 patients; 43/74 (58%) had steatohepatitis, and 12/74 (16%) had fibrosis. Conclusions Twenty percent of children with elevated aminotransferases on routine testing may hide non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. A careful diagnostic workup of persistent hypertransaminasemia in all obese subjects is warranted in the paediatric setting.