Background: Respiratory viral infections are one of the leading causes of pediatric hospitalization. While pulmonary manifestations are well documented, extrapulmonary effects such as liver involvement remain underexplored.Objectives: To assess the prevalence of liver dysfunction in children with confirmed viral respiratory infections and to determine whether elevated liver enzymes could serve as a marker of disease severity.Methods: A retrospective cross-sectional study was conducted at The University Medical City, a tertiary center in Oman, including children less than 13 years old with confirmed viral respiratory infections between January 2017 and December 2022. Collected data included demographics, presentation, lab tests, hospitalization duration, outcomes, and viral etiology. Patients were categorized based on alanine transaminase (ALT) levels: normal (<40 IU/L) or elevated (≥40 IU/L). Ethical approval was obtained [No.SQU-EC/273/2022, MREC# 2901].Results: Of 1,989 children less than 13 years with confirmed viral respiratory tract infections, 264 with monovirus infection and available liver function tests were included. Out of those,143 (54.2%) were boys and 121 (45.8%) were girls. The mean age was 6 years. The average hospital stay was 13.9 days.The prevalence of elevated ALT was 28.4% (75/264). It was significantly associated with longer hospital stay (22.4 vs. 9.7 days; p = 0.001). Mortality was significantly higher in the elevated ALT group compared to the normal ALT group (12/75 (16%) vs. 1/189 (0.5%), p < 0.0001). The highest liver enzyme abnormalities were found in Bocavirus virus (4/5, 80%). Patients with comorbidities were more likely to have hepatic dysfunction (p = 0.022). (figure)Conclusion: Liver dysfunction is common in pediatric respiratory viral infections and may serve as a marker of disease severity. Routine liver function test could be considered in hospitalized children with viral respiratory illness, particularly in those with comorbidities.
