| Distinct age-dependent phenotypes of abnormal liver
function tests derived from national Emergency
Department data |
Dong-Uk Kim1,2 
, Shinjie Choi1,2
, Yeji Kim1,2
, Lia Kim1,2
, Jung Ok Shim1,2
, Jin Soo Moon1,2
, Jong Woo Hahn1,3
, Hye Ran Yang1,3
, Ju Young Chang1,4
, Jae Sung Ko1,2
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1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
2Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
3Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
4Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea |
Correspondence:
Jae Sung Ko, Email: kojs@snu.ac.kr
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Received: 7 January 2026 • Revised: 18 February 2026 • Accepted: 4 March 2026 |
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| Abstract |
Background
Abnormal liver function tests (LFTs) are
frequently performed in Emergency Departments (EDs);
however, the systematic characterization of age-dependent
clinical phenotypes and pathogen associations remains
limited.
Purpose
Here we aimed to identify the distinct clinical
presentations and pathogen-specific associations of
pediatric and adult ED visits for abnormal LFTs.
Methods
This retrospective cohort study analyzed
26,874 ED visits for abnormal LFTs in South Korea's National
Emergency Department Information System (2019–
2023). Patients were stratified into pediatric (0–18 years)
and adult (19–64 years) groups. We characterized the
clinical
presentations, concurrent diagnoses, temporal
correlations with infectious pathogens, and metabolic
comorbidity patterns.
Results
The ED visits included 3,152 pediatric (11.7%)
and 23,722 adult patients (88.3%). Pediatric presentations
demonstrated fever-predominant profiles (47.3%), respiratory
symptoms (6.4%), and infectious disease diagnoses
(39.8%) as well as temporal correlations with respiratory
viruses (rhinovirus, r=0.30; adenovirus, r=0.28; P<0.001).
Adult presentations revealed previously unreported population-
level temporal associations with enteric pathogens,
including astrovirus (r=0.35), sapovirus (r=0.32),
enteropathogenic Escherichia coli (r=0.38), and enterotoxigenic
Escherichia coli (r=0.36, all P<0.001) coupled
with infectious gastroenteritis (20.9%) and upper gastrointestinal
disorders, including gastritis (18.3%). Adults
demonstrated clustering of the following metabolic comorbidities:
dyslipidemia (7.9%), hypertension (7.8%), and
diabetes (6.0%). During the coronavirus disease 2019 pandemic,
pediatric visits remained stable, whereas adult visits increased following the implementation of social
distancing measures (rate ratio, 0.82; P=0.004).
Conclusion
The ED presentation of abnormal LFTs
results
demonstrated distinct age-dependent phenotypes
with divergent temporal pathogen associations.
Pediatric cases reflected acute respiratory viral infections,
whereas adult presentations showed novel
population-level enteric pathogen associations with
upper gastrointestinal disorders and clusters of metabolic
comorbidities. These findings provide evidence
supporting age-stratified diagnostic approaches for
EDs. |
| Key Words:
Liver function tests, Emergency service,
Age factors, Communicable diseases, Metabolic syndrome |
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