Hepatic involvement in children with acute bronchiolitis

doi:10.4254/wjh.v14.i10.1907

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Oct 27, 2022 (publication date) through Feb 21, 2025

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World Journal of Hepatology

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1948-5182

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Retrospective Cohort Study

World J Hepatol. Oct 27, 2022; 14(10): 1907-1919
Published online Oct 27, 2022. doi: 10.4254/wjh.v14.i10.1907

Table 1 Demographic data of children with acute bronchiolitis (n = 166)

Demographic data		No. of patients (%)
Sex	Male	93 (56)
Sex	Female	73 (44)
Nationality	Bahraini	117 (70.5)
Nationality	Other	49 (29.5)
Gestational age (n = 140)	Term	111 (79.3)
Gestational age (n = 140)	Preterm	29 (20.7)
Age at presentation (mo), median (IQR)		3.4 (1.1-12.4)
Current age (mo), median (IQR)		30.3 (28.31-39.8)
Length of stay (d), median (IQR)		6.0 (3.0-11.0)

Values are presented as n (%) for categorical variables and median (interquartile range) for continuous variables. IQR: Interquartile range.

Table 2 Results of laboratory investigations in the 166 children who presented with acute bronchiolitis

Variable	Normal range	Mean	SD	Median	Minimum	Maximum	Tested patients (%)
White blood cell count (× 10⁹/L)	3.6-9.6	10.8	5.4	9.7	0.80	27.8	166 (100)
Hemoglobin level (g/dL)	12.0-14.5	11.5	2.3	11.0	5.7	20.0	166 (100)
Platelet count (× 10⁹/L)	150-400	410	179.7	383.5	14.5	971.0	166 (100)
Total serum protein (g/L)	64-82	57.8	8.7	58.0	25.0	96.0	161 (97)
Serum albumin (g/L)	38-54	41.5	10.7	41.0	17.0	143.0	161 (97)
Serum globulin (g/L)	15-30	18.0	10.7	17.0	6.0	140.0	161 (97)
Total bilirubin (µmol/L)	5-21	37.4	61.2	10.0	2.0	482.0	161 (97)
Direct bilirubin (µmol/L)	0-5	12.0	14.4	11.0	1.0	122.0	71 (42.8)
Indirect bilirubin (µmol/L)	< 18	56.0	46.0	27.0	1.0	454.0	71 (42.8)
Alkaline phosphatase (U/L)	150-420	242.6	141.7	198.0	58.0	841.0	161 (97)
Alanine aminotransferase (U/L)	< 41	25.6	30.2	19.0	6.0	247.0	161 (97)
Gamma glutamyl transferase (U/L)	< 18	63.2	80.0	32.0	6.0	526.0	145 (87.3)
Prothrombin time	10-14	13.7	2.8	12.9	9.5	25.2	46 (27.7)
INR	0.6-1.2	1.1	0.3	1.1	0.79	2.2	46 (27.7)
PTT (sec)	28-43	28.2	9.7	26.8	13.2	63.3	46 (27.7)
Fibrinogen (mg/dl)	217-496	285.9	213.8	233.8	0.0	1115.2	34 (20.48)
Thrombin time (sec)	15.6 -18.4	17.9	4.1	17.3	4.1	13.0	33 (19.87)
Random blood sugar (mmol/L)	3.6-8.9	5.7	1.4	5.2	4.0	10.0	53 (32)
Ammonia (µmol/L)	11-35	80.6	61.2	62.0	7.0	230.0	11 (6.6)
Lactic acid (mmol/L)	0.5-2.2	3.1	3.3	1.5	1.0	10.0	7 (4.2)
Lactate dehydrogenase (units/L)	250-650	1030.1	1281.9	531.5	3.0	3509.0	6 (3.6)
Iron profile (µg/dL)	11.6-31.3	9.4	5.7	8.0	4.0	19.0	9 (5.4)
CRP (mg/L)	0.3	26.8	39.2	9.5	10.0	297.0	166 (100)

SD: Standard deviation; INR: International normalized ratio; PTT: Partial thromboplastin time; CRP: C-reactive protein.

Table 3 Comparison of patients with and without liver function test abnormalities

Variable		Alanine aminotransferase level (n = 161)		P value
Variable		High (> 41 U/L), 14 (8.7)	Normal (≤ 41 U/L), 147 (91.3)	P value
Sex	Female	9 (64.3)	61(41.5)	0.157^a
	Male	5 (35.7)	86 (58.5)
Nationality	Bahraini	9 (64.3)	104 (70.7)	0.760^a
	Non-Bahraini	5 (35.7)	43 (29.3)
Gestational age (n = 135)	Term	8 (57.1)	98 (66.7)	0.683
	Preterm	1 (7.1)	28 (19.0)
Age at presentation (mo), mean ± SD		10.1 ± 12.8	10.6 ± 17.3	0.535^b
Age at the time of study (mo), mean ± SD		37.5 ± 13.2	37.8 ± 17.5	0.394^b
Length of hospital stay (d), mean ± SD		18.0 ± 19.3	13.4 ± 41.1	0.025^b
History of fever		9 (7.9)	105 (92.1)	0.552^a
White blood cell count (× 10⁹/L), mean ± SD		12.2 ± 7.0	10.6 ± 5.3	0.764^b
Hemoglobin (g/dL), mean ± SD		11.6 ± 2.1	11.5 ± 2.4	0.796^b
Platelet count (× 10⁹/L), mean ± SD		335.4 ± 194.8	417.6 ± 178.5	0.109^b
Total serum protein (g/L), mean ± SD		56.6 ± 7.3	57.9 ± 8.9	0.895^b
Serum globulin (g/L), mean ± SD		16.71 ± 3.69	18.1 ± 11.2	0.801^b
Serum albumin (g/L), mean ± SD		39.86 ± 5.89	41.63 ± 11.1	0.971^b
Total bilirubin (µmol/L), mean ± SD		29.4 ± 41.2	38.11 ± 62.81	0.794^b
Direct bilirubin (µmol/L), (n = 71), mean ± SD		24.1 ± 39.9	10.5 ± 5.7	0.722^b
Indirect bilirubin (µmol/L), (n = 71), mean ± SD		22.5 ± 17.9	62.0 ± 75.1	0.184^b
Alkaline phosphatase (U/L), mean ± SD		271.9 ± 217.2	239.9 ± 133.1	0.935^b
Gamma-glutamyl transferase (U/L), (n = 145), mean ± SD		92.4 ± 88.2	60.6 ± 79.0	0.080^b
Prothrombin time, (n = 46), mean ± SD		13.2 ± 1.6	13.8 ± 3.0	0.809^b
INR, (n = 46), mean ± SD		1.1 ± 0.1	1.2 ± 0.3	0.831^b
PTT, (n = 46), mean ± SD		25.5 ± 4.9	28.8 ± 10.4	0.579^b
Fibrinogen, (n = 34), mean ± SD		326.4 ± 387.2	277.3 ± 166.4	0.581^b
Thrombin time, (n = 33), mean ± SD		21.4 ± 7.3	16.9 ± 2.0	0.131^b
Random blood glucose, (n = 52), mean ± SD		6.0 ± 1.0	6.0 ± 1.0	0.905^b
Positive blood culture (n = 127)		2 (14.3)	10 (6.8)	0.278^a
Positive urine culture (n = 88)		3 (21.4)	4 (2.7)	0.030^a
Positive cerebrospinal fluid culture (n = 23)		0 (0.0)	1.0 (0.7)	1.000^a
Positive RSV test (n = 159)		6 (42.9)	46 (31.3)	0.356^a
Antibiotic use (n = 157)		11 (78.6)	115 (78.2)	1.000^a
Complications		2 (14.3)	28 (19)	1.000^a
Admission to the intensive care unit		1 (7.1)	10 (6.8)	1.000^a
Mortality		1 (7.1)	8 (5.4)	0.569^a

^aFisher’s exact test was used for categorical variables.

^bMann-Whitney U test was used for continuous variables.

Values are presented as n (%) or mean ± SD. Bold indicates a statistically significant difference with P < 0.05. SD: Standard deviation; INR: International normalized ratio; PTT: Partial thromboplastin time; RSV: Respiratory syncytial virus.

Table 4 Comparison of patients with acute bronchiolitis who were tested for liver enzymes at the time of presentation and at the time of follow up

Variable	Normal range	n	At the time of the presentation	At the time of follow-up	P value^a
Total serum protein (g/L)	64-82	65	59.0 ± 11.0	62.0 ± 11.0	0.011
Serum albumin (g/L)	38-54	65	42.0 ± 9.0	42.5 ± 7.0	0.467
Serum globulin (g/L)	15-30	65	18.0 ± 5.0	20.0 ± 6.0	0.008
Total bilirubin (µmol/L)	5-21	64	37.0 ± 49.0	28.0 ± 91.0	0.376
Direct bilirubin (µmol/L)	0-5	16	18.0 ± 28.0	51.0 ± 157.0	0.322
Indirect bilirubin (µmol/L)	< 18	15	56.0 ± 46.0	35.0 ± 50.0	0.103
Alkaline phosphatase (U/L)	150-420	64	240.0 ± 143.0	242.0 ± 121.0	0.897
Alanine aminotransferase (U/L)	< 41	61	31.0 ± 43.0	42.0 ± 88.0	0.371
Gamma-glutamyl transferase (U/L)	< 18	50	61.0 ± 75.0	41.0 ± 91.0	0.234

^aP value was calculated by the paired t-test.

Citation: Isa HM, Hasan AZ, Khalifa SI, Alhewaizem SS, Mahroofi AD, Alkhan FN, Al-Beltagi M. Hepatic involvement in children with acute bronchiolitis. World J Hepatol 2022; 14(10): 1907-1919
URL: https://www.wjgnet.com/1948-5182/full/v14/i10/1907.htm
DOI: https://dx.doi.org/10.4254/wjh.v14.i10.1907