Transaminase levels in ventilated children with respiratory syncytial virus bronchiolitis.
OBJECTIVE
To compare disease severity as judged by duration of ventilation, inotrope use and mortality in children ventilated for respiratory syncytial virus (RSV)-positive lower respiratory tract infection (LRTI) with and without elevated transaminase levels and to determine the aetiology of elevated transaminase levels in this patient group.


METHODS
Prospective observational study.


METHODS
Twenty-two-bed Paediatric Intensive Care Unit.


METHODS
Forty-eight ventilated children with RSV-positive LRTI.


RESULTS
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured daily. In patients with elevated transaminase levels infection with the following viruses was investigated: hepatitis A, B and C viruses, cytomegalovirus, Epstein Barr virus, adenovirus, influenza virus, and parainfluenza viruses (types I, II, and III). Elevated transaminase levels were detected in 22 (46%) patients. The duration of mechanical ventilation (geometric mean; 95% CI) was significantly ( P<0.05) longer in the group with elevated transaminase levels: 10.6 (9.4; 11.7) days versus 3.5 (2.8; 4.2) days. This difference remained significant in patients without congenital heart disease. Inotrope use was more common and all deaths occurred in the group with elevated transaminase levels ( P<0.05). All patients who died and all but two patients with inotrope requirements had underlying congenital heart disease. One patient with elevated transaminase levels had a simultaneous infection with influenza A virus.


CONCLUSIONS
RSV disease in ventilated children was more severe if transaminase levels were elevated. Transaminase level elevation was due to hepatitis in the majority of patients. In patients with congenital heart disease we also detected myocardial involvement.
Eisenhut
Michael
M
Paediatric Intensive Care Unit, Royal Liverpool Children's NHS Trust Alder Hey, Eaton Road, Liverpool L12 2AP, UK. michael_eisenhut@yahoo.com
Thorburn
Kentigern
K
Ahmed
Tageldin
T
D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007363:Intensive Care Units, Neonatal; D011446:Prospective Studies; D012121:Respiration, Artificial; D018113:Respiratory Syncytial Virus, Human / Q000472:pathogenicity*; D012141:Respiratory Tract Infections / Q000201:enzymology* / Q000628:therapy / Q000821:virology; D012720:Severity of Illness Index
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase