{
  "abstract": "Liver function tests (LFTs) are frequently requested in paediatric emergency departments (PEDs), often yielding incidental findings of derangement. 1 While many abnormalities are benign and transient, some reflect underlying liver pathology.2 There is limited guidance on interpreting mildly deranged LFTs and determining when follow-up is warranted.3 The aim of the study was to evaluate the demographic and clinical characteristics of children undergoing LFT testing in PED at a major urban paediatric hospital in Wales, and to determine associations with transaminitis and LFT derangement.This retrospective service evaluation included 80 children aged 6 months to 16 years who underwent LFT testing between August 2023 and August 2024. Clinical records were reviewed for biometrics, demographics, symptoms, past medical and drug history, nutritional status, and follow-up outcomes. Alanine aminotransferase (ALT) derangement (transaminitis) was used as a primary outcome due to its relative specificity as a marker of hepatocellular injury,4 and was defined based on the local reference ranges (ALT ≥26 IU/L in children aged 1-13 years, ≥23 IU/L in females 13-19 years old and ≥25 IU/L in males 13-19 years old). Using STATA software, univariable logistic regression was performed to assess predictors of transaminitis and LFT derangement, and linear regression was used to examine associations with ALT value.Of the 80 children, 41 (51.3%) had at least one LFT derangement and 18 (22.5%) had transaminitis. Due to missingness of data, BMI had to be excluded from the analysis. In univariate analysis, none of the variable were statistically significantly associated with transaminitis. Multivariable regression modelling could not be performed for transaminitis as only dehydration met the inclusion threshold. For LFT derangement, age and hepatotoxic medication use were included in the multivariable analysis but were not statistically significant. In multivariable analysis of ALT values, hepatological symptoms and acute febrile illness with liver symptoms were significantly associated with ALT elevation (coefficient = 347.66 and 347.84 respectively, both p < 0.001). These associations reflect a single patient with marked transaminitis. No other symptom groupings demonstrated significant associations.Only 7 children (38.9% of those with transaminitis) received follow-up. Three were diagnosed with the following: metabolic dysfunction-associated steatotic liver disease, gallstones, Epstein-Barr virus-induced hepatitis. The remaining four children had blood tests that normalised or remained mildly elevated, leading to discharge. The median ALT among those followed up was higher (129 IU/L, IQR 44.5 – 196.4) than in those not followed up (31 IU/L, IQR 28-53). This may reflect selective follow-up of patients with more pronounced derangement.The study was limited by its retrospective design, missing data, a small sample size and a single-centre source of data. However, it addressed a clinically relevant, under-researched area directly applicable to frontline practice, and could therefore be treated as a useful pilot study for further research.In summary, transaminitis is a common finding in children undergoing LFTs in PED but most cases are not followed up. Developing local protocols for LFT interpretation and follow-up could help ensure that significant cases are identified while avoiding unnecessary investigations.References Er A, Çakar S, Ermiş N, et al. Etiology, laboratory and clinical course of elevated transaminases in pediatric emergency department. J Pediatr Emergency and Intensive Care Med 2021 Apr 1;8(1):42–9.Bugeac N, Pacht A, Mandel H, et al. The Significance of Isolated Elevation of Serum Aminotransferases in Infants and Young Children. Archives of Disease in Childhood [Internet]. 2007 Dec 1 [cited 2025 Apr 24];92(12):1109–12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2066067/3. Vajro P, Maddaluno S, Veropalumbo C. Persistent hypertransaminasemia in asymptomatic children: a stepwise approach. World J Gastroenterol 2013;19(18):2740.Ventureira VF, Arnal IR, Martínez GR, et al. Evaluation of liver function tests in the paediatric patient. Anales De Pediatria 2021 Jun 1;94(6):359–65.",
  "authors": [
    {
      "affiliations": [
        "University Hospital of Wales",
        "Leeds General Infirmary",
        "Queen Mary University of London"
      ],
      "name": "Agata Chylinska"
    }
  ],
  "title": "OC40 Clinical characteristics, predictors, and outcomes of transaminitis in children presenting to a paediatric emergency department: a retrospective evaluation",
  "uid": "e6cc8ee6-31f0-524f-97aa-60982e8c7741"
}