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
Research background

Acute bronchiolitis caused by Respiratory syncytial virus (RSV) is the most common type of lower respiratory tract infection of viral etiology. It is occasionally associated with hepatocellular involvement, as indicated by the increase in liver enzymes, including aspartate aminotransferase and alanine transaminase.

Research motivation

Due to the limited data on liver involvement in acute bronchiolitis, we were motivated to study the prevalence of liver involvement in RSV-induced acute bronchiolitis and the associated factors.

Research objectives

To assess the frequency of impaired liver functions in infants with acute bronchiolitis and to detect the predicted clinical, radiological, and laboratory variables.

Research methods

We retrospectively reviewed demographic data, clinical presentation, laboratory results, radiological findings, and outcomes of infants with acute bronchiolitis admitted to the pediatric department, Salmaniya Medical Complex, Kingdom of Bahrain, collected from medical records in 2019-2020. Infants with high liver enzymes were compared to those with normal levels at the time of presentation and at follow-up.

Research results

One hundred sixty-six (57.8%) out of 287 patients with acute bronchiolitis 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 by PCR in 15 of them (28%). High ALT levels were found in 14 (8.7%) patients and ALT was normal in 147 (91.3%). Coagulation profiles were measured in 46 (27.7%) of 166 patients. High PT was present in 15 (32.6%), high INR was present in 13 (28.3%), and high APTT 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 was significantly associated with lengthy hospital stay (P < 0.05) and a 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.

Research conclusions

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.

Research perspectives

A proper evaluation of liver function during acute bronchiolitis is needed. Both diagnostic and therapeutic approaches are required to alleviate hepatic involvement in children with acute bronchiolitis.