Etiologies, Prognostic Factors, and Outcomes of Pediatric Acute Liver Failure in Thailand

Getsuwan, Songpon; Lertudomphonwanit, Chatmanee; Tanpowpong, Pornthep; Thirapattaraphan, Chollasak; Tim‐Aroon, Thipwimol; Wattanasirichaigoon, Duangrurdee; Treepongkaruna, Suporn

doi:10.5223/pghn.2020.23.6.539

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Biochemical parameters, both in isolation and by incorporation into prognostic scoring systems, are important prognosticators of outcome in PALF patients. Kathemann [28] et al, Di Giorgio [26] et al and few other studies [22,39] found significantly higher INR, peak bilirubin and peak ammonia levels in PALF patients with poorer outcomes, as with our cohort of patients. Higher peak lactate [22,40] has also been described in some studies as predictor of poor outcomes in PALF patients and has especially been studied as a component of KCHC in paracetamol-associated PALF patients.…”

Section: Discussionsupporting

confidence: 87%

“…Prognostic markers and scoring systems currently utilized to assess outcome are largely extrapolated from adult studies [15,16]. Findings in our study showed an increased number of patients who died prior to liver transplantation compared with other high and lowincome countries [21,22,28,29]. Although our study demonstrates the utility of dynamic scoring systems in PALF patients, it underscores the need for early referral and clinical monitoring in a tertiary center once the criteria for PALF have been met.…”

Section: Discussionmentioning

confidence: 58%

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Prognostic factors and scoring systems associated with outcome in pediatric acute liver failure

et al. 2022

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Background Pediatric acute liver failure (PALF) is an uncommon, devastating illness with significant mortality. Liver transplantation remains the mainstay of treatment for irreversible PALF. The purpose of this study was to determine the etiology and prognostic factors associated with outcome of PALF in South Africa and to evaluate prognostic scoring systems used. Methods Records of 45 pediatric patients younger than 16 years of age who presented with PALF from 1 January 2015 till 31 October 2020 were analysed. Patients were divided into two groups with one group consisting of patients with spontaneous recovery of the liver with supportive treatment (6/45:13.3%) and the second group consisting of patients with poor outcomes who demised (19/45: 42%) or underwent liver transplantation (20/45: 44%). Results The median age of presentation was 3.3 years (IQR 1.8–6.9) with the 1–5 years age group constituting majority of patients (55.6%). Median time to follow up was 6.1 months (IQR 0.2–28.8). Higher liver injury unit scores were observed in patients who had poorer outcomes (P = 0.008) with a threshold of greater than 246 having a sensitivity of 84% and specificity of 83% (P < 0.001). Higher peak PELD/MELD (P = 0.006) and admission UKELD (P = 0.002) scores, were found in patients with poorer outcomes. Kings College Hospital criteria (KCHC) was useful in predicting which patients would die without liver transplantation (P = 0.002). Liver transplantation was performed in 20/45 (44%) patients with a post transplantation 1 year patient and graft survival of 80%. Conclusion Although, survival of PALF patients was lower than high and other low-middle income countries, outcomes post transplantation were good. Our study demonstrates the utility of dynamic scoring systems in PALF patients, it underscores the need for early referral and clinical monitoring in a tertiary center once the criteria for PALF have been met.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 58%

Prognostic factors and scoring systems associated with outcome in pediatric acute liver failure

et al. 2022

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“…Such high incidence has occasionally been reported from the other endemic countries as well. A 2006 study from Thailand, a tropical country, found dengue to be the cause of ALF in 12 out of 35 children (34%) under 15 years of age but another recent study from Thailand attributed 15% of PALF to dengue (10,11). Deepak and Patel (12) from the Western part of India reported dengue to be the cause of PALF in 8.9% (5 of 56) but Kumar et al (13) from Northern India found dengue infection in 18.5% of PALF patients.…”

Section: Discussionmentioning

confidence: 99%

Acute Liver Failure in Dengue: A Common but Overlooked Entity in Pediatric Patients in Tropical Countries

Dogra

Kumar

Malhotra

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objective:The objective of the study is to estimate the incidence of acute liver failure (ALF) in dengue infection, understand the demographic and biochemical profiles, and identify prognostic factors associated with mortality. Methodology: This is a retrospective observational study. We evaluated the data of all pediatric dengue patients admitted over the last 5 years in our hospital to identify patients who fulfilled the criteria for pediatric ALF. Demographic profile, and biochemical and radiological parameters were assessed. Their outcomes and mortality data were analyzed to identify prognostic factors. Results: Thirty children with dengue infection were identified to have developed a during the ALF study period which was 29.1% (30 of 103) of all our ALF admissions. A total of 189 children with dengue infection needed admission during the same period and 15.8% (30 of 189) of them developed ALF. The mean duration of onset of ALF was 5.4 days after fever onset. Twenty-two patients (73%) survived, and 8 patients expired. High creatinine, low albumin level, and multisystemic involvement were identified as poor prognostic markers in those patients who did not survive. Conclusion: ALF is common in admitted severe dengue patients. A significant proportion of acute liver patients in endemic countries can be attributed to dengue infection. Low serum albumin, high creatinine, and multi-organ dysfunction during acute illness can be used as prognostic markers in these children. Multicentric prospective studies are needed to validate these results.

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“…Tương tự như nghiên cứu của chúng tôi, được thực hiện tại khoa Hồi sức Tăng cường -Chống độc bệnh viện Nhi đồng 1 trong khoảng thời gian từ năm 2011 đến năm 2014, tác giả Lê Ánh Ngọc cũng ghi nhận được hai nguyên nhân gây suy gan cấp ở trẻ em chiếm đa số trong mẫu nghiên cứu là sốc sốt xuất huyết và sốc nhiễm trùng với tỉ lệ lần lượt là 46,8% và 43,2% [6]. Nghiên cứu của Getsuwan tại Thái Lan cũng có những nét tương đồng, với gần 15% trẻ mắc suy gan cấp tại đây là do sốt xuất huyết [7]. Đáng chú ý, trong nghiên cứu của chúng tôi là không có bệnh nhân nào bị suy gan do viêm gan siêu vi A, B, C hay E. Ngược lại, theo nhiều nghiên cứu được thực hiện tại các quốc gia đang phát triển ở Châu Á, Châu Phi và Nam Mỹ thì HAV và HEV là nguyên nhân hàng đầu dẫn đến suy chức năng gan cấp tính ở trẻ em [8 -10].…”

Section: Bàn Luận đặC đIểm Nguyên Nhân Gây Suy Gan Cấpunclassified

Đặc điểm điều trị suy gan cấp ở trẻ em tại Khoa hồi sức tích cực Bệnh viện Nhi Đồng 1

Nguyễn Hoàng,

Phạm Văn

2022

PNTJMP

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- Mục tiêu: Xác định nguyên nhân, đặc điểm điều trị, kết quả và các yếu tố liên quan tử vong của bệnh nhân bị suy gan cấp được điều trị tại khoa Hồi sức Tăng cường - Chống độc bệnh viện Nhi đồng 1 từ 1/2018 đến 6/2021. - Phương pháp nghiên cứu: Nghiên cứu mô tả hàng loạt ca. - Kết quả: 102 trường hợp mắc suy gan cấp. Ở các nguyên nhân gây suy gan cấp, sốc là nguyên nhân hàng đầu (79,3%) với sốc nhiễm trùng và sốc sốt xuất huyết lần lượt là 43,1% và 23,5%. Không ghi nhận trường hợp nào do viêm gan siêu vi A, B hay C. Wilson là nguyên nhân duy nhất ở nhóm rối loạn chuyển hóa di truyền và không trẻ nào mắc suy gan cấp do ngộ độc thuốc. Các điều trị thường dùng: Natri ưu trương (43,1%), Manitol (30,4%), NAC (28%). 18 trẻ được tiến hành lọc máu liên tục (CRRT), tất cả đều được chỉ định khi có diễn tiến não gan giai đoạn III - IV kèm tăng NH3 ≥ 150 µmol/L hoặc có kèm suy thận. Có sự khác biệt có ý nghĩa giữa NH3 trước và sau 24 giờ CRRT. Trong 9 ca thay huyết tương, hầu như tất cả đều được chỉ định khi không đáp ứng với CRRT (89%) và đa số trẻ (67%) được thay với khối lượng lớn. Tỉ lệ tử vong chung là 40,2%. Các yếu tố liên quan tử vong gồm: Bệnh não gan độ IV (OR 20,27, p < 0,05), tăng NH3 máu (OR 1,013, p < 0,05) và giảm Hemoglobin (OR 0,737, p < 0,05). - Kết luận: Cần nhận biết và xử trí sớm sốc để hạn chế biến chứng tổn thương đa cơ quan. Nên nhanh chóng tiến hành CRRT khi trẻ có bệnh não gan nặng kèm NH3 tăng cao không đáp ứng với điều trị nội khoa. Abstract - Objectives: The aim of this study was to describe the causes, treatment characteristics, outcomes and mortality related factors in children with acute liver failure (ALF) admitted to the pediatric intensive care unit at children hospital 1 from January 2018 to June 2021. - Method: Case series study. - Results: A total of 102 children with ALF were admitted to the pediatric intensive care unit at children hospital 1 over the course of the study period. The most common causes of ALF were septic shock (43.1%) and Dengue shock syndrome (23.5%). None of our patients had viral hepatitis A, B or C. Wilson disease was the only cause identified in the hereditary metabolic disorder group. Acetaminophen overdose and other drugs’ intoxication severe enough to cause ALF were not seen during the period. Commonly used treatments were hypertonic saline (43.1%), Mannitol (30.4%) and NAC (28%). 18 patients received CRRT, which was indicated when these patients showed signs of advanced hepatic encephalopathy (Grade 3 - 4) and a level of serum ammonia greater than 150µmol/L or renal failure as a comorbid condition. There was a significant difference between the levels of serum ammonia before and 24-hour after CRRT. 9 patients underwent plasma exchange, which was mostly indicated in patients who had not responded to CRRT (89%). Most plasma exchanges (67%) were performed with high volume. Overall mortality rate was 40.2%. Risk factors for a fatal outcome in children with ALF include grade IV hepatic encephalopathy, raised level of serum ammonia and anemia. - Conclusions: Early recognition and aggressive therapy in pediatric shock are crucial to prevent multiple organ dysfunction syndrome. CRRT should be initiated in patients who show signs of advanced coma grades with a raised level of serum ammonia that do not respond to standard medical therapy.

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Etiologies, Prognostic Factors, and Outcomes of Pediatric Acute Liver Failure in Thailand

Cited by 6 publications

References 26 publications

Prognostic factors and scoring systems associated with outcome in pediatric acute liver failure

Prognostic factors and scoring systems associated with outcome in pediatric acute liver failure

Acute Liver Failure in Dengue: A Common but Overlooked Entity in Pediatric Patients in Tropical Countries

Đặc điểm điều trị suy gan cấp ở trẻ em tại Khoa hồi sức tích cực Bệnh viện Nhi Đồng 1

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