A new study suggests that elevated liver enzymes (transaminases) in hospitalized children with influenza could serve as an early warning sign of serious complications. Kids with high transaminase levels were more likely to be admitted to the ICU, stay in the hospital longer, and even die. Researchers say adding these markers to routine flu assessments could help doctors act faster and smarter.
A multicenter Italian study of 543 hospitalized children found that elevated transaminase levels — a marker of liver stress — were strongly associated with worse outcomes in kids with influenza. Children with high AST and/or ALT levels were more likely to experience severe symptoms like muscle weakness, myalgia, and hypovolemic shock, and faced significantly higher rates of ICU admission and longer hospital stays compared to those with normal levels.
The findings, published in Influenza and Other Respiratory Viruses, suggest that routinely checking liver enzymes during flu hospitalizations could help clinicians identify high-risk children earlier — enabling timely antiviral treatment, closer monitoring, or escalation to higher-level care. Notably, elevated transaminases were more common in influenza B cases than influenza A (40% vs. 20.6%).
By the Numbers:
Why it matters: Flu in children can escalate quickly, and identifying who's at greatest risk early is critical. If transaminase levels can reliably flag severity, they could become a simple, low-cost addition to flu risk stratification tools used in pediatric care.
