Bagus Setyoboedi
Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya/Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya

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Alterations in Liver Biomarkers Associated with The Consumption of Ursodeoxycholic Acid at A Tertiary Hospital in Indonesia: A Retrospective Cohort Study Nur Hanifah; Bagus Setyoboedi; Citrawati Dyah Kencono Wungu; Rendi Aji Prihaningtyas
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 32 No. 2 (2026)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v32i2.2453

Abstract

Bile excretion disorders, such as cholestasis could affect people of all ages, including newborns. Although it has been regularly used to treat cholestasis, the use of ursodeoxycholic acid in pediatric patients remains a topic of debate. This study aims to assess the impact of ursodeoxycholic acid treatment on liver biomarkers in pediatric cholestasis across distinct age groups (under 3 months and 3-36 months). This was an observational analytic study using the retrospective cohort method in children with cholestasis who had received ursodeoxycholic acid therapy for 2 weeks. Secondary data including routine liver function tests; aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and direct bilirubin were taken from medical records of the outpatient clinic in the Department of Child Health, Dr. Soetomo General Hospital, Surabaya, Indonesia, from January 2020 to December 2023. Subjects who met the inclusion criteria were divided into 2 groups based on age. The first group contains subjects with an age range of 1-3 months, while the other group contains subjects older than 3 months to 36 months. A total of 104 subjects were dominated by the male gender (56.07%). The results of the comparative test showed that the levels of AST, ALT, total bilirubin and direct bilirubin were decreased in both groups, except for ALT levels in children aged <3 months. Younger children had a significant increase in ALT levels after administration of ursodeoxycholic acid (281.8±165.2 vs 224.1±167.2, p =0.019). This was attributed to drug interactions due to the use of multiple medications that could not be controlled. Significant decreases occurred in the values of AST, total bilirubin, direct bilirubin (group 1) and AST (group 2) with sequential values were 179.2±139.2 vs 294.5±229.7, p =0.033; 10.8±4.5 vs 6.6±5.3 p =0.019; 7.3±3.6 vs 4.7±3.9 p <0.001 and 229.8±175.7 vs 229.6±210.9 p <0.001. While the difference in the values of the four parameters between the two groups was found in AST and total bilirubin marker. Ursodeoxycholic acid is effective in improving liver function biomarkers in pediatric cholestasis. Therapeutic response to ursodeoxycholic acid administration is more commonly found in younger age.
The Severity and Underlying Causes of Hypertransaminasemia in Children Nurarifah Destianizar Ali; Rendi Aji Prihaningtyas; Bagus Setyoboedi; Sjamsul Arief
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 32 No. 2 (2026)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v32i2.2469

Abstract

Hypertransaminasemia, characterized by elevated liver enzymes, is a common clinical finding in pediatric patients and can indicate various underlying conditions. Understanding the clinical demographics and the underlying causes of hypertransaminasemia is crucial for effective diagnosis and management. This study aimed to investigate the severity of liver enzyme elevations and their underlying etiologies. A cross-sectional study was conducted using medical records of pediatric patients. Data collected included patient demographics, laboratory results, and the diagnosis. In this study, the severity of hypertransaminasemia was categorized solely by Alanine Aminotransferase (ALT) levels, and underlying causes were classified as hepatic or non-hepatic. The reference values were determined by selecting the upper limits of normal (ULNs) for each gender and age group. A total of 1037 pediatric patients were included in this study. The majority were aged between 18 months and 12 years (60.5%), with a male predominance (52.1%). Based on the underlying cause group, 665 cases (64.1%) were of non-hepatic origin, while 372 (35.9%) were hepatic origin. Among the elevated ALT, 545 (52.6%) were mild, 276 (26.2%) were moderate, and 216 (20.8%) were severe. Etiological investigations revealed drug-induced liver injury (20.8%) as the major cause. There was a significant difference between the underlying causes of hypertransaminasemia and ALT levels (p =0.001), while no significant difference observed (p =0.652) regarding the degree of hypertransaminasemia increase and ALT levels (p =0.652). There was no correlation between ALT levels and the causative diagnosis in the severe hypertransaminase group (p =0.818; r =-0.016). Further prospective studies are required to validate these results and refine clinical approaches to patients with hypertransaminasemia.