Volume 30, Number 4—April 2024
CME ACTIVITY - Research
Deaths Associated with Pediatric Hepatitis of Unknown Etiology, United States, October 2021–June 2023
, Julia M. Baker1, David E. Sugerman, Umesh D. Parashar, Sarah Reagan-Steiner, Hannah L. Kirking, Paul A. Gastañaduy, Jacqueline E. Tate, and Hepatitis of Unknown Etiology Group2
Table 3
Clinical and demographic characteristics of 8 children with hepatitis of unknown etiology, United States, October 1, 2021–June 6, 2023 *
| Characteristic | Value |
|---|---|
| Demographic characteristics | |
| Age | |
| Median age (range) | 2.4 (0.2–6.3) |
| 0–11 mo | 2 (25.0) |
| 1–2 y | 4 (50.0) |
| 3–9 y | 2 (25.0) |
| Sex | |
| F | 3 (37.5) |
| M | 5 (62.5) |
| Race/ethnicity | |
| Hispanic or Latino | 5 (62.5) |
| Black, non-Hispanic | 2 (25.0) |
| White, non-Hispanic |
1 (12.5) |
| Clinical characteristics | |
| Underlying conditions at initial visit | |
| Immunocompromised† | 2 (25.0) |
| Comorbidities that may have increased risk for hepatitis‡ | 2 (25.0) |
| No underlying conditions | 4 (50.0) |
| Reported signs and symptoms§ | |
| Respiratory | 6/8 (75.0) |
| Gastrointestinal | 7/8 (87.5) |
| Hepatic | 8/8 (100.0) |
| Systemic | 7/8 (87.5) |
| Laboratory findings | |
| Highest alanine transaminase, median (range), U/L | 4,852 (219–5,648) |
| Highest aspartate aminotransferase, median (range), U/L | 7,500 (786–10,000) |
| Highest total bilirubin, median (range), mg/dL | 13.7 (1.3–19.4) |
| Highest international normalized ratio, median (range) | 8.0 (1.4–13.0) |
| Highest ammonia, median (range), µmol/L |
126.0 (60.3–801.0) |
| Duration of symptoms before admission, d | |
| Median (range) | 7 (1–36) |
| 0–7 | 5 (62.5) |
| 8–14 | 1 (12.5) |
| >15 | 2 (25.0) |
| Duration of hospital stay, d | |
| Median (range) | 14.5 (<1– 18) |
| 0–2 | 2 (25.0) |
| 3–14 | 2 (25.0) |
| >15 | 4 (50.0) |
| Physical findings | |
| Hepatomegaly | 5/8 (62.5) |
| Hepatic encephalopathy | 4/8 (50.0) |
| Splenomegaly | 2/7 (28.6) |
| Ascites | 3/7 (42.9) |
| Outcomes¶ | |
| Acute liver failure | 7 (87.5) |
| Liver transplant | 2 (25.0) |
*Values are no. (%) except as indicated. †Immunocompromised at the time of initial presentation. One child immunosuppressed due to ongoing cancer treatment. One child immunocompromised due to a liver transplant. ‡One child was small for gestational age and 1 child had a history of poor weight gain and possible gastrointestinal disorder. §Symptoms are not mutually exclusive; all children reported multiple symptoms. Respiratory signs/symptoms include cough, congestion, runny nose, shortness of breath, conjunctivitis, sore throat, or wheezing. Gastrointestinal signs/symptoms include diarrhea, nausea, vomiting, or abdominal pain. Hepatitis signs/symptoms include dark colored urine, pale stool, jaundice, or scleral icterus. Systemic signs/symptoms include fatigue, decreased appetite, or fever. See Appendix Table 2 for data by patient. ¶Not mutually exclusive. Acute liver failure was defined based on documentation written in the medical chart or medical chart abstraction indicating acute liver failure occurred.
1These authors contributed equally to this article.
2Members of the group are listed at the end of this article.