Risk factors for delayed recovery of liver enzymes in pediatric primary Epstein–Barr virus hepatitis

Objective Children with primary Epstein–Barr virus (EBV) infection frequently develop varying degrees of liver dysfunction. This study aimed to identify clinical risk factors associated with delayed liver enzyme recovery in pediatric primary EBV hepatitis. Methods In this retrospective study, 338 children diagnosed with primary EBV hepatitis and admitted to our department between January and December 2024 were enrolled. Based on follow-up liver enzyme recovery, patients were categorized into a normal recovery group and a delayed recovery group. Demographic, clinical, and laboratory data were collected from medical records. Univariate analysis was first performed to identify potential risk factors for delayed recovery, followed by multivariate logistic regression to determine independent predictors. The predictive value of these factors was assessed using receiver operating characteristic (ROC) curve analysis. A risk scoring system was developed based on the regression coefficients. Results Among the 338 patients, 228 exhibited normal recovery of liver enzymes, while 110 showed delayed recovery. Patients with delayed recovery had significantly longer fever duration, longer hospital stays, and a higher incidence of hepatomegaly (all P < 0.05). Laboratory findings revealed that the delayed recovery group had significantly higher levels of lymphocyte percentage, atypical lymphocyte percentage, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and ferritin, but significantly lower levels of neutrophil percentage, double-negative T cell percentage, and NK cell percentage compared to the normal recovery group (all P < 0.05). Multivariate logistic regression identified fever duration, neutrophil percentage, and ALT level as independent risk factors for delayed recovery. A scoring system was devised assigning 1 point each for fever duration ≥6 days and neutrophil percentage ≤19.0%, and 2 points for ALT ≥118.0 U/L. Using a cutoff score of ≥3 points, this model predicted delayed liver enzyme recovery with 68.20% sensitivity and 73.70% specificity. The area under the ROC curve for this prediction score was 0.77 [95% confidence interval (CI): 0.70–0.84]. Conclusions Lower neutrophil percentage, higher ALT level, and prolonged fever duration were identified as independent risk factors for delayed recovery of liver enzymes in pediatric primary EBV hepatitis. Clinicians should closely monitor high-risk patients and strengthen outpatient follow-up.