Published online Oct 27, 2022. doi: 10.4254/wjh.v14.i10.1907
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
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.
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.
To assess the frequency of impaired liver functions in infants with acute bronchiolitis and to detect the predicted clinical, radiological, and laboratory variables.
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.
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.
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.
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.