Age-Dependent Hepatic Involvement in Pediatric Epstein–Barr Virus Infection: Clinical Associations and Biochemical Recovery Patterns

<b>Background</b>: Epstein-Barr virus (EBV) infection is common in childhood and frequently accompanied by liver enzyme abnormalities. Although hepatic involvement is generally self-limited, pediatric data on predictors of hepatitis and biochemical recovery dynamics remain limited. This study aimed to evaluate the frequency and severity of hepatic involvement in children with primary EBV infection and identify clinical and laboratory features associated with hepatitis. <b>Methods</b>: This retrospective cohort study included children aged 0-18 years with serologically confirmed primary EBV infection at a tertiary center between January 2015 and November 2024. Patients with cytomegalovirus co-infection, hepatotropic viral infections, chronic liver disease, hepatotoxic drug exposure, or incomplete records were excluded. Demographic, clinical, and laboratory data were collected. Hepatic involvement was defined as ALT elevation above age-adjusted upper limits. Group comparisons utilized appropriate parametric and non-parametric tests, and logistic regression assessed predictors of hepatitis. <b>Results</b>: A total of 294 patients were included (median age: 6.1 years), of whom 48.6% were male. Hepatitis occurred in 59.2% of cases. Children with hepatitis were older than those without (median 6.7 vs. 5.3 years, <i>p</i> < 0.001). Logistic regression demonstrated that increasing age independently predicted hepatitis (odds ratio per year increase: 1.010; 95%CI 1.005-1.015; <i>p</i> < 0.001). Median time to ALT normalization was 20 days, and no patient developed acute liver failure. <b>Conclusions</b>: Hepatic involvement is common in pediatric EBV infection and is more frequent in older children. Despite significant biochemical abnormalities, all patients recovered fully with supportive care. Recognizing age-related risk and typical recovery patterns may reduce unnecessary investigations and guide appropriate management in pediatric EBV hepatitis.