| Abstrakt: |
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). The primary organs involved in COVID 19 patients is the respiratory system. The second most affected system is the gastrointestinal system. A mild rise in liver enzymes is common in the patients with COVID-19. In this study, it was aimed to retrospectively evaluate the elevations in liver enzyme levels in pediatric patients with COVID-19. METHODS: This retrospective study was conducted at the Selcuk University Faculty of Medicine, Division of the Pediatric Infectious Diseases in Konya, Turkey. Medical records of children who were diagnosed as COVID-19 via oropharyngeal and nasopharyngeal polymerase chain reaction (PCR) between March and August 2020 were analyzed retrospectively. Those patients with known gastrointestinal any liver diseases were excluded from the study. Serum AST and ALT enzyme levels were used to evaluate hepatocellular type injury, while cholestatic type liver injury was evaluated according to serum levels of ALP and GGT enzymes. Local normal ranges (according to the age groups of children) were used to calculate the fold increase above the upper limit of the normal range (ULN). The "R value" was used to help determine the likely types of liver injury (hepatocellular versus cholestatic) in patients with elevated AST and ALT or ALP and GGT. The R ratio was calculated according to the formula R=(ALT÷ULN ALT)/(alkaline phosphatase ÷ ULN alkaline phosphatase). In clinical situations where it was suspected that ALP elevations were from an extrahepatic source, GGT level was used. If the R values were =5, 2-5 or =2, they were defined as hepatocellular, mixed or cholestatic type of liver injuries, respectively.. RESULTS: Of the 300 children, 157 (52.2%) patients were female, 143 (47.6%) were male, and the median age was 9.3 years (range, 14 days-18 years). At admission, about 13,6% (n=41) of the children had abnormal liver test results. 23 patients (56%) had high levels of ALT and/or AST (<2 X ULN). Only three patients (7%) had more levels of ALT and/or AST (>3 X ULN). The high rates of serum GGT levels in 4 patients (36.3%), one patient (9%) and 6 patients (54.5%) were <2 X ULN, <3 X UNL, and >3 X UNL, respectively. In the all 10 patients with high serum ALP values for according to their ages, the elevation rates of serum ALP levels were about <2 x UNL. Regarding the patterns of abnormal liver test results showed hepatocellular type (12.1%), cholestatic type (48.7%), and were mixed type (39%) injuries. No patient had liver failure during follow-up.. CONCLUSION: COVID-19 should also be considered in the differential diagnosis of liver enzyme abnormalities. [ABSTRACT FROM AUTHOR] |
