Hypertransaminasaemia Predicts Severe Outcomes in Critically Ill Children, Suggests Study
Italy: A new study found that elevated transaminase levels (hypertransaminasaemia) may serve as an early and reliable marker of systemic disease severity in children, identifying those at increased risk of complications, intensive care unit (ICU) admission, and mortality. Early recognition can aid in timely risk stratification and management.
The findings, published in Influenza and Other Respiratory Viruses, come from a study led by Marco Poeta and colleagues from the Pediatric Infectious Disease Unit, Department of Maternal and Child Health, University Hospital “Federico II”, Naples, Italy. The researchers investigated whether elevated transaminase levels could predict disease severity in children hospitalized with influenza and distinguish those at greater risk of adverse outcomes.
For this purpose, the researchers conducted a multicentre retrospective cohort study across 10 tertiary care hospitals in Italy between January 2023 and May 2025, involving 543 hospitalized children with acute viral respiratory infections. Among them, 127 had laboratory-confirmed influenza (102 influenza A and 25 influenza B). Children were grouped by the presence of hypertransaminasaemia (defined as AST and/or ALT levels exceeding twice the upper limit of normal), and their clinical characteristics, laboratory findings, treatment needs, and outcomes were compared.
The study revealed the following findings:
- 24.4% of children hospitalized with influenza had elevated transaminase levels, compared with 7.2% of those with non-influenza respiratory viral infections.
- Hypertransaminasaemia was more common in influenza B than influenza A (40.0% vs. 20.6%).
- Children with elevated transaminase levels had significantly higher rates of asthenia, myalgia, and hypovolaemic shock.
- The elevated transaminase group showed evidence of greater systemic inflammation, including lower platelet counts and fibrinogen levels and markedly higher ferritin concentrations.
- The biochemical profile suggested that elevated transaminase levels reflected systemic and muscle involvement rather than primary liver injury.
- Children with elevated transaminase levels had longer hospital stays than those with normal levels (10.2 vs. 5.8 days).
- Elevated transaminase levels were associated with an increased need for high-flow oxygen therapy, intravenous fluids, and ICU admission.
- Children with hypertransaminasaemia had a more than fourfold higher likelihood of ICU admission.
- Both deaths reported during the study occurred in children with elevated transaminase levels, highlighting its potential value as an early marker of severe influenza.
The researchers suggested that incorporating AST and ALT measurements into routine assessment and clinical severity scores could enable earlier identification of high-risk children, supporting closer monitoring, timely antiviral treatment, and referral to higher-level care when needed.
The study was limited by its retrospective design, which cannot establish causality, and by its inclusion of only hospitalized children, potentially limiting the generalizability of the findings.
Overall, the findings suggest that elevated transaminase levels are a simple and readily available marker of severe influenza in children and may help improve early risk stratification and clinical management.
Reference:
Poeta, M., Moracas, C., Venturini, E., Sgubbi, S., Valentino, M. S., Folgori, L., Petrarca, L., Cafagno, C., Maglione, M., Cascone, A., Colomba, C., Romero, A., Midulla, F., Indolfi, G., Giacomet, V., Licari, A., Galli, L., & Guarino, A. (2026). Hypertransaminasemia Is a Marker of Severity in Children Hospitalized for Influenza. Influenza and Other Respiratory Viruses, 20(7), e70283. https://doi.org/10.1111/irv.70283
Next Story