Acute liver injury in hospitalized children: clinical and etiological profile from a tropical country

BACKGROUND: Clinical spectrum of children presents with acute liver injury (ALI) is quite wide, ranging from asymptomatic enzyme elevation to severe hepatic dysfunction. This study aimed to evaluate the clinical and etiological profile and outcomes of children 1 month to 12 years presented with ALI at a tertiary care hospital in North India. METHODS: This prospective observational study enrolled 132 children with AL. Detailed clinical evaluation, liver function tests, and etiological workups were performed. The severity of ALI was classified based on liver enzyme levels, and patient's diagnosis and outcomes were assessed. RESULTS: Among the enrolled children (47.7% female, mean age 69.3 months), fever (85.6%) was the most common presenting symptom. ALI severity was classified as mild (29.5%), moderate (15.1%), and severe (55.3%). The leading cause of ALI was Acute Viral hepatitis (37.1%), followed by Enteric fever (21.9%) and Dengue fever. Non-Hepatotropic viruses such as Influenza, Adenovirus were identified in 11 (8.3%). Infants primarily presented with mild ALI related to viral infections, whereas children aged 1-5 years and >5 years had higher proportions of severe ALI. Follow-up investigations at two weeks showed improvement in 77.1% of patients, while 22.9% had persistent liver enzyme elevation. CONCLUSION: Infectious causes, particularly viral hepatitis, remain the predominant etiology of ALI in Indian children. Severe ALI was frequently associated with viral hepatitis, Enteric fever and dengue. In addition, Non-hepatotropic viruses are important cause of ALI. Consideration of these common illnesses is important to avoid unnecessary investigations and parental anxiety.