Alanine aminotransferase elevation in hospitalized children with infectious mononucleosis: independent associations with Epstein-Barr virus DNA load, age, and sex.

Background: Alanine aminotransferase (ALT) elevation is common in pediatric infectious mononucleosis, but its relationship with Epstein-Barr virus (EBV) DNA load, age, and sex remains incompletely defined. We examined this association and identified independent correlates across pediatric age groups. Methods: In this single-center retrospective cross-sectional study, we included 365 children hospitalized with EBV-associated infectious mononucleosis who had admission EBV DNA quantification. Patients were grouped by age as <3, 3-6, and ≥6 years. Multivariable linear regression was used to evaluate the association between EBV DNA load and ALT level, while multivariable logistic regression assessed factors associated with ALT elevation. Age-stratified and interaction analyses examined whether these associations differed by age group, and sensitivity analyses tested the stability of the findings. Results: Higher log10(EBV DNA) was associated with higher ln(ALT) in the fully adjusted model [adjusted Conclusions: Among hospitalized children with EBV-associated IM, higher EBV DNA load, older age, and female sex were independently associated with ALT elevation, findings that may help contextualize ALT elevation at initial evaluation.