Li Xun, Yan Haipeng, Li Xiao, Luo Ting, Wang Xiangyu, Xie Longlong, Yang Yufan, Liu Pingping, Zhang Xinping, Huang Jiaotian, Lu Xiulan, Xiao Zhenghui
Pediatrics Research Institute of Hunan Province, Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital), Changsha, China.
Pediatric Intensive Care Unit, Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital), Changsha, China.
Eur J Pediatr. 2025 Jul 12;184(8):477. doi: 10.1007/s00431-025-06319-x.
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are the most commonly used biomarkers for liver injury, but they are insufficient on their own as prognostic indicators. This study aims to develop a simple method that combines aminotransferases with other routinely available liver function parameters to identify pediatric patients at high risk of adverse outcomes. Medical records from 144,044 pediatric patients with ALT and AST test results were analyzed. The trend in the change of adverse outcome rates by percentiles of AST and ALT was examined to identify a sub-population potentially at risk of liver injury. Within this sub-population, a logistic regression-based prediction rule was developed using liver injury and function markers to predict adverse outcomes. Results showed that an AST level of 80 IU/L can serve as a threshold to identify pediatric patients at higher risk for adverse outcomes. The prediction rule for AST-based risk stratification for liver injury (ASTLI) was developed as follows: among patients with AST > 80 IU/L, the presence of up to two abnormalities in total protein (or albumin), lactate dehydrogenase, or international normalized ratio (or prothrombin time) can help further stratify those at high risk for adverse outcomes (training set: sensitivity = 76%, specificity = 73%; validation set: sensitivity = 76%, specificity = 79%). Age and disease subgroup analysis demonstrated potential for broad applicability across various pediatric populations.
The stratification rule could serve as a fast risk stratification tool for liver injury among pediatric patients.
• ALT and AST are the most commonly used biomarkers for liver injury. • An elevation in AST and ALT does not always necessitate specific therapeutic intervention nor does it necessarily correlate with disease severity or prognosis.
• A stratification rule was developed to identify pediatric patients at high risk for adverse outcomes. It incorporates AST > 80 IU/L and up to two abnormalities in total protein (or albumin), lactate dehydrogenase, or international normalized ratio (or prothrombin time).
天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）是肝损伤最常用的生物标志物，但它们单独作为预后指标并不充分。本研究旨在开发一种简单方法，将转氨酶与其他常规可用的肝功能参数相结合，以识别有不良结局高风险的儿科患者。分析了144,044例有ALT和AST检测结果的儿科患者的病历。通过AST和ALT百分位数检查不良结局率变化趋势，以识别可能有肝损伤风险的亚组人群。在该亚组人群中，使用肝损伤和功能标志物制定基于逻辑回归的预测规则，以预测不良结局。结果显示，AST水平80 IU/L可作为识别有不良结局较高风险儿科患者的阈值。基于AST的肝损伤风险分层预测规则（ASTLI）如下制定：在AST＞80 IU/L的患者中，总蛋白（或白蛋白）、乳酸脱氢酶或国际标准化比值（或凝血酶原时间）中存在多达两项异常，有助于进一步对有不良结局高风险者进行分层（训练集：敏感性=76%，特异性=73%；验证集：敏感性=76%，特异性=79%）。年龄和疾病亚组分析表明该规则在不同儿科人群中具有广泛适用性。
该分层规则可作为儿科患者肝损伤的快速风险分层工具。
• ALT和AST是肝损伤最常用的生物标志物。• AST和ALT升高并不总是需要特定治疗干预，也不一定与疾病严重程度或预后相关。
• 制定了一种分层规则，以识别有不良结局高风险的儿科患者。该规则纳入了AST＞80 IU/L以及总蛋白（或白蛋白）、乳酸脱氢酶或国际标准化比值（或凝血酶原时间）中多达两项异常。
