Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2022; 14(10): 1907-1919
Published online Oct 27, 2022. doi: 10.4254/wjh.v14.i10.1907
Hepatic involvement in children with acute bronchiolitis
Hasan M Isa, Asma Z Hasan, Sara I Khalifa, Sana S Alhewaizem, Abdulrahman D Mahroofi, Fatema N Alkhan, Mohammed Al-Beltagi
Hasan M Isa, Sara I Khalifa, Fatema N Alkhan, Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain
Hasan M Isa, Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain
Asma Z Hasan, Department of Pediatrics, Sulwan Psychiatric Hospital, Manama 973, Bu Quwah, Bahrain
Sana S Alhewaizem, Department of Pediatrics, Dream Reem Medical Center, Muharraq 50573, Bahrain
Abdulrahman D Mahroofi, Department of Pediatrics, King Hamad University Hospital, Muharraq 24343, Bahrain
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, Dr. Sulaiman Al-Habib Medical Group, Bahrain, Manama 26671, Bahrain
Author contributions: Isa HM, Hasan AZ, Khalifa SI, Alhewaizem SS, Mahroofi AD, Alkhan FN, and Al-Beltagi M collected the data and wrote and revised the manuscript.
Institutional review board statement: The study was ethically approved by the Research and Research Ethics Committee for Governmental Hospitals, Salmaniya Medical Complex, Bahrain (Approval No. 27130220).
Informed consent statement: Consent was not needed as the study was retrospective without exposure of the patient's data.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: Data are available upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mohammed Al-Beltagi, MBChB, MD, MSc, PhD, Chairman, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, AlBahr Street, Tanta 31527, Algharbia, Egypt.
Received: June 14, 2022
Peer-review started: June 14, 2022
First decision: August 18, 2022
Revised: August 22, 2022
Accepted: October 10, 2022
Article in press: October 10, 2022
Published online: October 27, 2022

Respiratory syncytial virus (RSV) is a prevalent cause of lower respiratory tract infections. It may be associated with hepatocellular involvement, as indicated by increased liver enzymes aspartate aminotransferase and alanine transaminase (ALT).


To evaluate the rate of increased liver enzyme levels in children with acute bronchiolitis and correlate them with clinical, laboratory, and radiological variables.


The study was a retrospective review of the medical records of children who presented with acute bronchiolitis when admitted to the Pediatric Department, Salmaniya Medical Complex, the Kingdom of Bahrain, between 2019 and 2020. We collected the demographic data, the clinical presentation, the laboratory and radiological findings, and the clinical outcomes. We compared the patients with elevated liver enzymes to those with normal levels at the time of presentation and at follow-up.


We included 166 (57.8%) of 287 patients with acute bronchiolitis who fulfilled the inclusion criteria. Ninety-three (56%) patients were males. The median age at presentation was 3.4 (interquartile range 1.1 to 12.4) mo. Fifty-four (28%) patients tested positive for RSV, which was confirmed in 15 of them (28%) by PCR. Laboratory findings of 161 patients tested at presentation showed high ALT levels in 14 (8.7%) patients and normal ALT in 147 (91.3%). Coagulation profiles were measured in 46 (27.7%) of 166 patients. High prothrombin time was present in 15 (32.6%), a high international normalized ratio was present in 13 (28.3%), and high activated partial thromboplastin time was present in three (6.5%). Thrombin time was elevated in nine (27.3%) of 33 patients. Five (21.7%) of 23 patients with available radiological data had hepatomegaly; one of them had findings suggestive of fatty infiltration. High ALT had a significant association with lengthy hospital stays (P < 0.05) and positive urine culture (P < 0.05). Seventy (42.2%) patients had documented follow-up with liver function tests over a median follow-up period of 10.2 (IQR, 2.4-23.3) mo. Total serum protein and serum globulin levels were normalized at the follow-up time, with a significant P value of < 0.05.


This study showed a low prevalence of liver function involvement in patients with acute bronchiolitis with a benign course. However, there was a rising trend in ALT during follow-up. Prolonged hospital stay and positive urine cultures were associated with elevated liver enzymes.

Keywords: Children, Acute bronchiolitis, Liver function tests, Respiratory syncytial virus

Core Tip: How frequent is hepatic involvement in children with acute bronchiolitis? Furthermore, what are the predicted factors? To answer these questions, we conducted this retrospective study. Despite the low prevalence of impaired liver function in patients with acute bronchiolitis and the benign course, there was a rising trend in alanine aminotransferase levels during follow-up. Elevated liver enzymes were linked to an extended hospital stay and positive urine cultures. Therefore, children with acute bronchiolitis should be monitored and followed up with liver function tests.