799 Serum Transaminase Elevations in Infants with Acute Gastroenteritis:Is it Hepatic Hypoferfusion or Rota Virus Associated Hepatitis?
Objective:: to examine the frequency of hepatic transaminase elevations in infants with acute gastroenteritis. Methods: Over a 8- weeks period, 35 of 130 infants admitted with acute gastroenteritis were found to have human rotavirus (HRV) gastroenteritis using stool antigen testing. Sera 130 infants were analyzed for alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), total and direct bilirubin, and creatinine. Results: Thirty four infants (26%) had elevated ALT and AST. ALT elevations were 1-3 times the normal in 24(∽18%) and 6-20 times the normal in 10(∽8%) infants; the latter group showed the clinical and biochemical criteria of ischemic hepatopathy. In all infants transaminases normalized within 3-10 days. Transaminase elevations were not significantly associated with age, sex, duration of gastroenteritis or with any of the following symptoms; fever (>38), vomiting or blood in the stools. A border line significant association was detected between HRV stool positivity and elevated ALT&AST levels (40% HRV positive VS. 21% HRV negative odd ratio=2.5 95%CI 1-3.2 p=0.05). Infant with severe dehydration had an estimated 31.5 fold higher odds of having elevated ALT & AST compared with those no dehydration(57,4% respectively). Multivariate logistic regression analysis, showed that severe dehydration is still significantly associated with elevated Transaminase levels. Conclusion: our data suggest that liver injury during gastroenteritis in infants is quit frequent but always self limiting if the underlying perfusion disturbance caused by severe dehydration is corrected. Rotavirus positivity was marginally associated with elevated transaminase levels.