Trends in the Clinical Severity of Pediatric Acute Hepatitis Due to Hepatitis A Virus and Nonhepatitis A Virus Etiologies: A Call for Action

Abstract Objective: Hepatitis A virus (HAV) remains a major cause of acute hepatic illness in children in low-and middle-income countries. With changing epidemiology and increasing hospitalization among older children, comparative data distinguishing HAV from other causes of pediatric acute hepatitis remain limited. This study evaluated clinical characteristics, laboratory derangements, disease severity, and outcomes of pediatric acute hepatitis, comparing HAV with non-HAV etiologies and identifying predictors of adverse outcomes. Materials and Methods: This retrospective hospital-based study included children (<18 years) admitted with acute hepatic illness. Clinical features, laboratory parameters, complications, Length of Stay (LOS), and outcomes were analyzed. Disease severity was assessed using alanine aminotransferase (ALT) ≥1000 IU/L and an exploratory composite severity score incorporating ALT ≥1000 IU/L, international normalized ratio (INR) ≥1.4, bilirubin ≥6 mg/dL, and hepatic encephalopathy. Results: A total of 105 children were included, comprising 45 hepatitis A cases (anti-HAV immunoglobulin M positive) and 60 non-HAV etiologies. Children with HAV were younger (median 7 vs. 9 years; P = 0.027) and demonstrated significantly higher transaminases, bilirubin, and INR compared with non-HAV cases (all P < 0.01). Hepatic encephalopathy occurred in 26.7% of HAV cases. Prolonged hospitalization (≥6 days) was frequent but comparable between groups. INR ≥1.4 strongly predicted prolonged LOS (odds ratios 46.4; P = 0.002). ALT correlated with AST (ρ =0.88) and LOS (ρ =0.40). One mortality occurred in the HAV cohort. Conclusion: Pediatric hepatitis A demonstrates greater biochemical severity than non-HAV acute hepatic illnesses, although overall outcomes are similar. Early identification of coagulopathy may assist in risk stratification and optimizing management of hospitalized children with acute hepatitis.