Alanine aminotransferase elevation in hospitalized children with infectious mononucleosis: independent associations with Epstein-Barr virus DNA load, age, and sex.
Source: PubMed, NCBI / U.S. National Library of Medicine
Alanine aminotransferase (ALT) elevation is common in pediatric infectious mononucleosis, but its relationship with Epstein-Barr virus (EBV) DNA load, age, and sex remains incompletely defined. We examined this association and identified independent correlates across pediatric age groups. In this single-center retrospective cross-sectional study, we included 365 children hospitalized with EBV-associated infectious mononucleosis who had admission EBV DNA quantification. Patients were grouped by age as <3, 3-6, and ≥6 years. Multivariable linear regression was used to evaluate the association between EBV DNA load and ALT level, while multivariable logistic regression assessed factors associated with ALT elevation. Age-stratified and interaction analyses examined whether these associations differed by age group, and sensitivity analyses tested the stability of the findings. Higher log10(EBV DNA) was associated with higher ln(ALT) in the fully adjusted model [adjusted = 0.32, 95% confidence interval (CI): 0.24-0.41; < 0.001], corresponding to an approximately 38% higher ALT level for each 10-fold increase in EBV DNA load. In the primary logistic model, EBV DNA load, age, and sex were associated with ALT elevation. Compared with children aged <3 years, the adjusted odds ratios were 2.08 (95% CI: 1.15-3.74) for those aged 3-6 years and 5.89 (95% CI: 3.04-11.42) for those aged ≥6 years. Male sex was associated with lower odds of ALT elevatio
Abstract
Alanine aminotransferase (ALT) elevation is common in pediatric infectious mononucleosis, but its relationship with Epstein-Barr virus (EBV) DNA load, age, and sex remains incompletely defined. We examined this association and identified independent correlates across pediatric age groups. In this single-center retrospective cross-sectional study, we included 365 children hospitalized with EBV-associated infectious mononucleosis who had admission EBV DNA quantification. Patients were grouped by age as <3, 3-6, and ≥6 years. Multivariable linear regression was used to evaluate the association between EBV DNA load and ALT level, while multivariable logistic regression assessed factors associated with ALT elevation. Age-stratified and interaction analyses examined whether these associations differed by age group, and sensitivity analyses tested the stability of the findings. Higher log10(EBV DNA) was associated with higher ln(ALT) in the fully adjusted model [adjusted = 0.32, 95% confidence interval (CI): 0.24-0.41; < 0.001], corresponding to an approximately 38% higher ALT level for each 10-fold increase in EBV DNA load. In the primary logistic model, EBV DNA load, age, and sex were associated with ALT elevation. Compared with children aged <3 years, the adjusted odds ratios were 2.08 (95% CI: 1.15-3.74) for those aged 3-6 years and 5.89 (95% CI: 3.04-11.42) for those aged ≥6 years. Male sex was associated with lower odds of ALT elevation (adjusted odds ratio: 0.29, 95% CI: 0.17-0.51). The EBV DNA load-ALT association was similar across age groups and remained stable in sensitivity analyses. Among hospitalized children with EBV-associated IM, higher EBV DNA load, older age, and female sex were independently associated with ALT elevation, findings that may help contextualize ALT elevation at initial evaluation.