Relation of transaminase levels with severity of Hepatitis A in children.

Objectives: To determine the sensitivity, specificity and diagnostic accuracy of serum alanine transaminase and serum aspartate transaminase in detecting the presence of severe Hepatitis A in children. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Pediatrics, Combined Military Hospital, Rawalpindi Pakistan, Jan to Sep 2022. Methodology: This study was conducted on 201 patients diagnosed with acute hepatitis A. All patients underwent testing for serum ALT, AST and LDH levels as well for PT/INR. Patients were labelled as suffering from severe hepatitis if INR was greater than 1.5. A 2x2 table was constructed to calculate the sensitivity, specificity and diagnostic accuracy for serum ALT, AST, ALT/AST ratio and ALT/LDH ratio in detecting the presence of severe hepatitis. Results: The mean age of the sample at the time of the study was 7.47±2.54 years, while 103(51.2%) were female. Serum ALT levels showed a sensitivity of 81.6% and a specificity of 36.0%. Serum AST had a sensitivity and specificity of 86.2% and 27.2% for the same, while the ALT/LDH ratio and the AST/LDH ratio had a sensitivity and specificity of 88.5% and 39.5%, and 100% and 1.7%, respectively for the detection of presence of severe Hepatitis A. Lastly, the ALT/AST ratio had 0% sensitivity and 100% specificity for the detection of severe hepatitis A. Conclusion: Liver enzyme levels and various associated ratios have low sensitivity and specificity for the detection acute severe hepatitis A.