Abstract: Objective To elucidate the clinical characteristics and identify determinants impacting the course of adenovirus-associated liver injury among a cohort of 236 pediatric patients. Methods Between April 2019 and April 2023, 572 pediatric patients with adenovirus infection were admitted to our hospital and stratified into two cohorts based on liver function: 236 in the liver injury group and 336 in the non-liver injury group. Comprehensive analysis of clinical data was conducted, employing multi-factorial logistic regression to identify risk factors associated with adenovirus-induced liver injury in children. Results In our cohort, pediatric patients with adenovirus-associated liver injury(n=236) demonstrated significantly higher rates of male gender(64.0%), severe pneumonia(19.1%), gastroenteritis(8.1%), wheezing(37.3%), respiratory distress(27.5% for shortness of breath and 20.3% for dyspnea), heart failure(10.6%), and mixed infections(53.0%) compared to those without, liver injury(P<0.05). Additionally, clinical and laboratory parameters including age, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBiL), gamma-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), and length of hospital stay were significantly elevated in the liver injury group compared to their counterparts, indicating a more severe clinical profile(P<0.05). Conversely, bronchiolitis prevalence, hemoglobin levels, and interleukin-10 (IL-10) were lower in patients with liver injury, underscoring the complexity of adenovirus impact on pediatric health. Multivariable logistic regression identified severe pneumonia, elevated GGT, and LDH levels as independent predictors of liver injury, highlighting their potential as diagnostic markers(P<0.05). Conclusion Adenovirus-associated liver injury predominantly affects male pediatric patients of younger age, with a notably high incidence observed among those presenting with severe pneumonia. The clinical presentation is primarily characterized by fever and severe pneumonia. Furthermore, GGT and LDH levels emerge as significant biochemical markers, influencing the risk and severity of adenovirus-associated liver injury. This underscores the importance of recognizing specific clinical and laboratory parameters for the early identification and management of this condition in the affected pediatric population.

Key words: Adenovirus, Liver injury, Clinical features, Influencing factors, Children