Hepatobiliary system lesions in children with COVID-19. Literature review and own observations

Abstract

Background: The relevance of this topic is due to the increasing incidence of hepatobiliary system in patients infected with SARS-CoV-2. COVID-19-associated hepatitis occurs in 15 - 65% of adult patients and 6 - 27% of children. Aim: To determine the association of hepatobiliary disorders with different variants of SARS-CoV-2 in children with coronavirus infection (COVID-19) who underwent inpatient treatment during a pandemic. Materials and Methods: 945 case histories of children from birth to 17 years of age, who were hospitalized in KCCCIDH in Kyiv, Ukraine with a diagnosis of coronavirus disease in the period from June 2020 to February 2022, were retrospectively studied. Among them were selected cases with elevated bilirubin, ALT and AST. The peculiarities of the results of instrumental and laboratory researches were determined. A distinction was made by age and periods of the pandemic. Statistical software EZR v. 1,54 was used to conduct a statistical study of the obtained results, using the methods of descriptive statistics. Results: An increase in ALT was observed in 8.4% (72/854) cases, an increase in AST in 19% (162/854) patients and an increase in total bilirubin in 3,6% (31/854) patients. In the age structure there was a predominance of all indicators in groups of children from birth to 1 year and age category 1 - 5 years. According to ultrasound, hepatomegaly was registered in 165 (17,5%) with a predominance in children 1 - 5 years, which accounted for 57 (6%) cases. There was a statistically significant increase in ALT and AST during the fourth wave compared to previous outbreaks, p < 0,001. Conclusion: The dependence of transaminase changes on the COVID-19 period in children was revealed. Liver damage may be related to SARS-CoV-2 virus. However, there is still a need for further research to study this relationship in detail and to understand the pathogenetic mechanisms of hepatitis in coronavirus infection in children.