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Journals / Turkish Journal of Clinics and Laboratory / 2026 / Sayı: 1

Etiological and clinical characteristics of childhood hypertransaminasemia: a retrospective study

Çocukluk çağı hipertransaminazemisinin etiyolojik ve klinik özellikleri: retrospektif bir çalışma

Demet Teker Düztaş(Şanlıurfa Eğitim ve Araştırma Hastanesi, Çocuk Gastroenteroloji Kliniği)0000-0003-3986-9523
Aydın Bozkaya(Harran University Faculty of Medicine, Departments of Pediatrics)0000-0001-8800-2753
Pages
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Publication Date
2026-03-29
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Although these subgroups showed higher biochemical abnormalities, their etiologic patterns and normalization times were similar to the overall cohort.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: This the study aimed to describe the etiologic distribution, clinical characteristics, and outcomes of hypertransaminasemia in children.
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Key Findings & Data:Material and Methods: This retrospective cohort study was conducted using electronic medical records of children aged 1 month–18 years who presented with persistent transaminase elevation between January 2023 and July 2024.
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Conclusion & Impact:Although these subgroups showed higher biochemical abnormalities, their etiologic patterns and normalization times were similar to the overall cohort.
🔬Design:Araştırma Makalesi
📍Scope:2023 Verileri
⚙️Variables:hipertransaminazemi · pediatrik karaciğer hastalığı · etiyoloji

Abstract

Aim: This the study aimed to describe the etiologic distribution, clinical characteristics, and outcomes of hypertransaminasemia in children. Material and Methods: This retrospective cohort study was conducted using electronic medical records of children aged 1 month–18 years who presented with persistent transaminase elevation between January 2023 and July 2024. Hypertransaminasemia was defined as alanine aminotransferase (ALT) >45 IU/L and/or aspartate aminotransferase (AST) >50 IU/L on at least two measurements with elevation persisting for at least 3 months. Patients with extrahepatic cholestasis or insufficient data were excluded. Demographic, clinical, laboratory, and imaging findings were collected, and etiologies were categorized. Subgroup analyses were performed based on cholestasis and ALT >10× the upper limit of normal (ULN). Results: Among 6886 first-time clinic visits, 214 children (3.1%) met the inclusion criteria. The cohort was predominantly male (55.6%) with a median age of 2.3 years, and parental consanguinity was notably high (79.9%). Infectious causes accounted for the majority of cases (65%), while metabolic/genetic disorders (9.3%), drug-induced liver injury (7%), metabolic dysfunction–associated steatotic liver disease (MASLD) (3.3%), and autoimmune disease (1.4%) were less frequent; 14% remained idiopathic. ALT >10×ULN was observed in 20.6% of patients, and cholestasis in 25.7%. Although these subgroups showed higher biochemical abnormalities, their etiologic patterns and normalization times were similar to the overall cohort. Follow-up data were available for 172 patients (80.4%); among them, transaminase levels normalized in 128 (74.4%), with a median time to normalization of 37.5 days (IQR 26.6–70). Conclusion: Hypertransaminasemia appears to be strongly influenced by regional factors, and establishing standardized pediatric reference ranges in Türkiye would substantially improve diagnostic accuracy.

Özet

Amaç: Bu çalışma, çocuklarda hipertransaminazeminin etiyolojik dağılımını, klinik özelliklerini ve izlem sonuçlarını tanımlamayı amaçlamaktadır. Gereç ve Yöntemler: Ocak 2023–Temmuz 2024 tarihleri arasında persistan transaminaz yüksekliği ile başvuran 1 ay–18 yaş aralığındaki çocukların elektronik tıbbi kayıtları kullanılarak retrospektif bir kohort çalışması yürütüldü. Hipertransaminazemi, en az üç ay arayla yapılan iki ayrı ölçümde alanin aminotransferaz (ALT) >45 IU/L ve/veya aspartat aminotransferaz (AST) >50 IU/L olarak tanımlandı. Ekstrahepatik kolestazı olan ve/veya verileri yetersiz bulunan hastalar çalışma dışı bırakıldı. Demografik, klinik, laboratuvar ve görüntüleme verileri kaydedildi ve etiyolojiler sınıflandırıldı. Alt grup analizleri, kolestaz varlığına ve ALT düzeyinin normalin üst sınırının 10 katından yüksek olup olmamasına göre gerçekleştirildi. Bulgular: İlk başvuru yapan 6886 çocuk arasında 214’ü (%3,1) çalışma kriterlerini karşıladı. Olguların çoğu erkekti (%55,6) ve yaş ortancası 2,3 yıl idi; ebeveynler arası akrabalık oranı ise dikkat çekici düzeyde yüksekti (%79,9). Enfeksiyöz nedenler en sık etiyolojiyi oluşturdu (%65). Metabolik/genetik hastalıklar (%9,3), ilaç ilişkili karaciğer hasarı (%7), metabolik disfonksiyonla ilişkili yağlı karaciğer hastalığı (MASLD) (%3,3) ve otoimmün karaciğer hastalıkları (%1,4) daha düşük oranlarda saptandı; olguların %14’ünde ise etiyolojik neden belirlenemedi. Hastaların %20,6’sında ALT düzeyi >10×ULN, %25,7’sinde kolestaz mevcuttu. Bu alt gruplarda biyokimyasal bozukluklar daha belirgin olmakla birlikte, etiyolojik dağılım ve normalleşme süreleri genel kohort ile benzerdi. Toplam 172 hastanın (%80,4) takip verilerine ulaşıldı; bu hastaların 128’inde (%74,4) transaminaz düzeyleri normale döndü. Medyan normalleşme süresi 37,5 gün (IQR: 26,6–70) olarak saptandı. Sonuç: Hipertransaminazemi etiyolojisinin bölgesel faktörlerden güçlü biçimde etkilendiği görülmektedir. Türkiye’de çocuklara özgü standardize referans aralıklarının oluşturulması, tanısal doğruluğu önemli ölçüde artıracaktır.

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Cite This Article

Düztaş, D. T., Bozkaya, A. (2026). Etiological and clinical characteristics of childhood hypertransaminasemia: a retrospective study. Turkish Journal of Clinics and Laboratory, Sayı: 1. https://doi.org/10.18663/tjcl.1832567

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References (27)

  1. Senior JR. Alanine aminotransferase: a clinical and regulatory tool for detecting liver injury-past, present, and future. Clin Pharmacol Ther 2012; 92: 332-39.
  2. Costa JM, Pinto SM, Santos-Silva E, Moreira-Silva H. Incidental hypertransaminasemia in children-a stepwise approach in primary care. Eur J Pediatr 2023; 182: 1601-09.
  3. Pacifico L, Ferraro F, Bonci E, Anania C, Romaggioli S et al. Upper limit of normal for alanine aminotransferase: quo vadis? Clin Chim Acta 2013; 422: 29-39.
  4. Serdaroglu F, Koca T, Dereci S, Akcam M. The etiology of hypertransaminasemia in Turkish children. Bosn J Basic Med Sci 2016; 16: 151-56.
  5. Hudson OD, Nunez M, Shaibi GQ. Ethnicity and elevated liver transaminases among newly diagnosed children with type 2 diabetes. BMC Pediatr 2012; 12: 174.
  6. Ros Arnal I, Reyes Andrade J, Mercadal Hally M, Blesa Baviera LC, Garcia Tirado D et al. Diagnostic action against hypertransaminasemia in paediatrics: Consensus document of SEGHNP, AEPap and SEPEAP. An Pediatr (Engl Ed) 2022; 96: 448.e1-11.
  7. Lee Y, Yi DY, Lee YM, Choi SY, Choi YJ et al. A Multicenter Study of Real-world Practice for Management of Abnormal Liver Function Tests in Children with Acute Infectious Diseases. J Korean Med Sci 2021; 36: e310.
  8. Arnell H, Fischler B. Laboratory evaluation of hepatobiliary disease. In: Pediatric Hepatology and Liver Transplantation. Springer; 2019: 57-66.
  9. Vajro P, Maddaluno S, Veropalumbo C. Persistent hypertransaminasemia in asymptomatic children: a stepwise approach. World J Gastroenterol 2013; 19: 2740-51.
  10. Iorio R, Sepe A, Giannattasio A, Cirillo F, Vegnente A. Hypertransaminasemia in childhood as a marker of genetic liver disorders. J Gastroenterol 2005; 40: 820-26.
  11. Sanri A, Kirsaclioglu CT, Sanri E, Sayli TR. Etiological evaluation of the elevated transaminases in children. Cumhuriyet Med J 2020; 42: 56-64.
  12. Basaran MK, Cicek T. Causes of hypertransaminasemia in children, single-center experience. Fam Pract Palliat Care 2021; 6: 56-61.
  13. Er A, Cakar S, Ermis N, Ozkerim D, Caglar A et al. Cocuk Acil Serviste Transaminaz Yuksekligi Nedenleri, Laboratuvar ve Klinik Seyir. J Pediatr Emerg Intensive Care Med 2021.
  14. Feldman AG, Sokol RJ. Neonatal Cholestasis. Neoreviews 2013; 14: e81-95.
  15. Li X, Zhou XD, Wu J, Zhao Z, Xie F et al. Pediatric MASLD in China: epidemiology, screening, diagnosis, and management. Lancet Reg Health West Pac 2025; 64: 101717.
  16. Danan G, Teschke R. RUCAM in Drug and Herb Induced Liver Injury: The Update. Int J Mol Sci 2015; 17: 14.
  17. Danan G, Teschke R. Roussel Uclaf Causality Assessment Method for Drug-Induced Liver Injury: Present and Future. Front Pharmacol 2019; 10: 853.
  18. Fontana RJ, Liou I, Reuben A, Suzuki A, Fiel MI et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology 2023; 77: 1036-65.
  19. European Association for the Study of the Liver (EASL). Clinical Practice Guidelines on the management of autoimmune hepatitis. J Hepatol 2025; 83: 453-501.
  20. Kim TS, Hur TH, Lim SJ, Bin JH, Hahn SH et al. A rise and fall in AST and ALT level in nonspecific reactive hepatitis. Korean J Pediatr 2008; 51: 396-400.
  21. Schwimmer JB, Dunn W, Norman GJ, Pardee PE, Middleton MS et al. SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology 2010; 138: 1357-64.
  22. Park SH, Park HY, Kang JW, Park J, Shin KJ. Aminotransferase upper reference limits and the prevalence of elevated aminotransferases in the Korean adolescent population. J Pediatr Gastroenterol Nutr 2012; 55: 668-72.
  23. Kang Y, Park S, Kim S, Koh H. Estimated Prevalence of Adolescents with Nonalcoholic Fatty Liver Disease in Korea. J Korean Med Sci 2018; 33: e109.
  24. Celtik C, Erbas H, Kursun OS, Bostancioglu M. The reasons of elevated serum transaminases in childhood. Turk J Biochem 2008; 33: 175-81.
  25. Moreira-Silva H, Maio I, Bandeira A, Gomes-Martins E, Santos-Silva E. Metabolic liver diseases presenting with neonatal cholestasis: at the crossroad between old and new paradigms. Eur J Pediatr 2019; 178: 515-23.
  26. Minemura M, Tajiri K, Shimizu Y. Liver involvement in systemic infection. World J Hepatol 2014; 6: 632-42.
  27. Hegarty R, Dhawan A. Fifteen-minute consultation: The child with an incidental finding of elevated aminotransferases. Arch Dis Child Educ Pract Ed 2018; 103: 228-30.