Prognostic Value of Elevated Liver Enzymes for Mortality among Critically Ill Children Admitted to the Pediatric Intensive Care Unit

Abstract

Objectives: This study aims to identify the prevalence, etiology, and prognostic value of elevated liver enzymes (AST and ALT) for mortality among critically ill pediatric intensive care unit (PICU) patients. Methods: This prospective, descriptive study enrolled patients aged 1 month to 15 years old admitted to the PICU of Vietnam National Children's Hospital from August 2020 to July 2021. Clinical and laboratory variables were recorded at the time of admission. Serum AST/ALT levels were recorded on admission and day 3 from PICU admission. Elevated liver enzymes were defined as serum levels exceeding twice the upper normal values. All patients were followed until PICU discharge or day 28 in the PICU. Multiple logistic regression was performed to identify independent prognostic factors for the outcomes.  Results: 227 critically ill children, 62.6% boys, median age 7 (IQR 2-31) months, 61.7% aged less than 1 year old were included in the study. The proportion of elevated ALT/AST on admission and day 3 was 23.0%/33.9% and 30.3%/24.6%, respectively. The common causes of elevated AST/ALT were sepsis (56.7%), shock (41.2%), and hypoxemia (35.1%). Overall, the mortality rate was 21.1%. There was no association between levels of AST/ALT on admission and day 3 with mortality among critically ill children. PELOD-2 score (OR, 1.18; 95%CI, 1.10 – 1.27) and INR (OR, 2.15; 95%CI, 1.24 – 3.72) on admission were associated with mortality. Conclusion: Elevated serum liver enzymes, specifically AST and ALT, are commonly observed in critically ill children in the PICU; however, these elevations are not associated with an increased risk of mortality.