Measurement practices of alanine aminotransferase in children: Temporal changes and etiology for increased values

Data on alanine aminotransferase (ALT) measurement practices and diagnoses associated with increased values are limited. We evaluated these issues by collecting ALT measurements from 1- to 16-year-old patients investigated in 1992-2018 in a tertiary center. Diagnoses were gathered in 2008-2018. Altogether 145,092 measurements from 28,118 children were taken 42% undergoing repeated testing. Testing increased from 21/1000 to 81/1000 children and the prevalence of elevated values fluctuated between 18% and 26%. An increase was seen especially in emergency care and departments of rheumatology, gastroenterology, hemato-oncology, and psychiatry. Common acute causes associated with elevated ALT were infections (45%), hemato-oncologic conditions (17%), and external reasons (13%), whereas autoimmune diseases (28%), psychiatric conditions (14%), and metabolic-dysfunction associated steatotic liver disease (10%) were common chronic causes. In conclusion, ALT testing increased 3.9-fold while the proportion of increased values remained stable, indicating that increased testing was justified. However, in some departments the testing efficiency was low. image What is Known Excessive laboratory testing may cause unnecessary downstream evaluations and burden for patients and healthcare. Real-life data on the alanine aminotransferase (ALT) testing practices, efficiency, temporal changes, and the diagnoses associated with increased values in children are lacking.What is New ALT testing increased 3.9-fold 1992-2018 in a tertiary center, whereas the prevalence of abnormal results fluctuated 18%-26%. The testing was most frequently and increasingly ordered by emergency care and outpatient departments of rheumatology, gastroenterology, hemato-oncology, and psychiatry. The most common acute diagnoses associated with elevated ALT were infections, hemato-oncologic diseases, and external reasons, while common chronic causes were autoimmune and psychiatric conditions and metabolic dysfunction-associated steatotic liver disease.