Severe hypertransaminasaemia during the acute hepatitis of unknown origin alert of 2022

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INTRODUCTION: The impact of acute severe hepatitis of unknown origin in children (SHIC) subject to a medical alert in 2022 medical alert is poorly understood. MATERIALS AND METHODS: Observational study of the incidence, aetiology and clinical presentation of acute hypertransaminasaemia (HTRA) with laboratory values in the severe range (ALT and/or AST ≥ 500 U/L) in paediatric patients (age 0 to 16 years) in one health care zone from 2012 to 2022, comparing the periods of the SHIC alert and the SARS-CoV2 pandemic with previous years. RESULTS: The incidence of severe HTRA of any cause was 195.28 per 100 000 blood tests, with an incidence of 181.38 in the SHIC alert period and 166.09 during the SARS-CoV-2 pandemic, without statistically significant differences. Hepatitis of unknown origin accounted for 7.42% of total cases and transaminase levels normalised in 126 days (SD, 99.4). During the SHIC alert period there was a nonsignificant trend towards a higher incidence, as occurred in 2012 and 2018. In this group of cases, there was a significant increase in the presence of fever, vomiting and upper respiratory symptoms and lower levels of albumin and alkaline phosphatase. One patient required a liver transplant. CONCLUSIONS: In our setting, there was no significant increase in the incidence of severe HTRA of any aetiology or of unknown source during either the SHIC alert or the SARS-CoV2 pandemic. In the SHIC alert period, a clinical pattern emerged characterised by an increase in nonspecific infectious symptoms, so we cannot rule out a higher prevalence of an infectious agent different from the usual involved pathogens, but it did not cause a significant change in epidemiological trends.

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