Clinical Epidemiological Investigation Of Abnormal Liver Function Tests In Hospitalized Children

Objective: To investigate the epidemiology of abnormal liver function tests(LFTs)of hospitalized children in Fuzhou area and the aim is to appreciate the abnormal LFTs and provide a reference for clinical practice.Method: Children with LFTs within 48 hours after hospitalization in the pediatric ward of the first affiliated hospital of Fujian medical university were included from Jan 2015 to Dec 2017,and the clinical data and LFTs results of all subjects were analyzed retrospectively.SPSS 22.0 software was used for the statistical analysis,Chi-square test comparison among groups,and ?=0.05 as a significant test standard.Result: Abnormal LFTs were observed in 1033/3006(34.36%),and there were no significant differences between boys and girls(P>0.05).Abnormal LFTs were 462/796(55.9%)in infants,341/992(31.45%)in toddlers,78/391(14.83%)in preschool and 152/827(13.91%)in school-age respectively,and the differences among them were statistically significant(?2=327.53,P=0.00).Evaluate severity of abnormal LFTs:(1)796/3006(26.48%)AST increase,of which 632/796(79.40%)was marginal,127/796(15.95%)mild,34/796(4.27%)moderate,and 3/796(0.38%)serious.324/3006(10.78%)ALT increase,of which 184/324(56.79%)marginal,95/324(29.32%)mild,43/324(13.27%)moderate,and 2/324(0.62%)serious.(2)Among 324 with ALT increase,171(52.78%)AST/ALT>1.(3)137/3006(4.56%)with TBIL>42.5?mol/L,of which 71/137(56.79%)mild,23/137(29.32%)moderate,32/137(13.27%)serious,and 11/137(0.62%)very serious;68/3006(2.26%)with DBIL >17?mol/L.(4)138/3006(4.59%)inpatients ALB decreased.PT was tested in 197 inpatients,and 30.96%(61/197)PT was prolonged.Among the 5 with hepatic failure,1 was marginal,2 mild and 2 moderate,but none serious,and abnormal LFTs of these inpatients were serious according to the AST/ALT ratio,TBIL,DBIL,ALB and PT evaluation standard.There were significant differences in LFTs abnormalities with different systemic diseases,and ranked in the top 3 as follows hepatobiliary disease(98.84%,85/86),blood system diseases(68.42%,13/19)and urological diseases(55.84%,43/77)respectively.Only 197/1033(19.08%)were diagnosed with abnormal LFTs at the time of discharge,and certain causes could be found in 135 cases(68.53%)involving 26 kinds of disease,and ranked the top 3 as follows EB virus infection(37/135,27.4%),cytomegalovirus infection(31/135,23.0%),and biliary atresia(13/135,9.6%)in those with clear diagnosis.Of the 836 without diagnosed of abnormal LFTs,693(83.22%)with infection diseases and 526(73.28%)with history of drugs therapy recently.Conclusion: Abnormal LFTs of hospitalized children is frequently,especially in infants,and marginal and mild abnormal of LFTs mainly.AST,ALT,AST/ALT ratio,TBIL,DBIL,ALB,PT could be used to evaluate the severity of abnormal LFTs.Hepatobiliary disease,blood system diseases and urological diseases are the most common diseases with abnormal LFTs.Infections,especially viral infections and medication are the major causes of abnormal LFTs.LFTs may be helpful for early identification and treatment of liver injury during the clinical practice.