Therapeutic plasma exchange and continuous renal replacement therapy in pediatric dengue-associated acute liver failure: A case series from Vietnam

Thanh, Nguyen Tat; Dat, Nguyen Tat; Thinh, Tran Ngoc; Phuong, Ngo Thi Mai; Thanh, Mai Thi Hoai; Bao, Nguyen Trung; Son, Pham Thai; Viet, Do Chau; Tung, Trinh Huu; Thien, Vu; Luan, Vo Thanh

doi:10.1016/j.transci.2022.103617

Cited by 12 publications

(17 citation statements)

References 40 publications

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“…Dengue-associated acute liver failure was defined as an acute episode of severe hepatic dysfunction with biochemical evidence of liver injury in children without preexisting chronic liver diseases, liver-induced coagulopathy not corrected by vitamin K supplementation, an international normalized ratio (INR) > 1.5, encephalopathy or INR > 2.0, with or without encephalopathy. [17,23]…”

Section: Methodsmentioning

confidence: 99%

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Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome

Nguyen,

et al. 2023

Medicine

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Dengue-associated complications, including dengue shock syndrome, severe respiratory distress, and pediatric acute liver failure (PALF), are associated with high mortality rates in patients with dengue. There is increasing prevalence of overweight and obesity among children worldwide. Obesity may activate inflammatory mediators, leading to increased capillary permeability and plasma leakage in patients with dengue. Several studies have shown a correlation between obesity and DSS, but did not include dengue fatality or PALF. Therefore, we hypothesized possible associations between obesity and critical dengue-associated clinical outcomes among PICU-admitted children with DSS, including dengue-related mortality, mechanical ventilation (MV) requirements, and dengue-associated PALF. The nutritional status of the participants was assessed using World Health Organization growth charts. A total of 858 participants with complete nutritional data were enrolled in this study. Obesity was significantly associated with risk of severe respiratory failure and MV support (odds ratio = 2.3, 95% CI: 1.31–4.06, P < .01); however, it was not associated with dengue-associated mortality or acute liver failure. Obese pediatric patients with DSS should be closely monitored for severe respiratory distress and the need for high-flow oxygenation support, particularly MV, soon after hospitalization.

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Section: Methodsmentioning

confidence: 99%

“…[16] Despite its rarity, dengue-associated PALF is associated with a high mortality, ranging from 25% to roughly 60 %. [16–18]…”

Section: Introductionmentioning

confidence: 99%

Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome

Nguyen,

et al. 2023

Medicine

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“…analyses after adjusted with severe bleeding and positive hemoculture, as main causes of fatality in dengueassociated PALF (12). Such combination intervention was associated with normalization of liver function, neurologic status, and biochemistry.…”

Section: At the Bedsidementioning

confidence: 96%

“…The TPE solution was fresh frozen plasma, and the standard-volume TPE was set at 1.5 times the patient's total plasma volume. We did extracorporeal priming with red blood cells mixed with normal saline 0.9% to achieve a hematocrit of 45% (equivalent to 90 mL) in children weighing less than 9 kg (16,17) (12). The rationale that CRRT should be combined with TPE was based on high prevalence of acute renal failure, highly elevated serum lactate acidosis and ammonia levels reported in patients with acute liver failure (8).…”

Section: Therapeutic Plasma Exchangementioning

confidence: 99%

Combined Therapeutic Plasma Exchange and Continuous Renal Replacement Therapy in Children With Dengue-Associated Acute Liver Failure and Shock Syndrome: Single-Center Cohort From Vietnam*

Chau

Trinh

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: Pediatric acute liver failure (PALF) is a fatal complication in patients with severe dengue. To date, clinical data on the combination of therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) for managing dengue-associated PALF concomitant with shock syndrome are limited. DESIGN: Retrospective cohort study (January 2013 to June 2022). PATIENTS: Thirty-four children. SETTING: PICU of tertiary Children’s Hospital No. 2 in Vietnam. INTERVENTIONS: We assessed a before-versus-after practice change at our center of using combined TPE and CRRT (2018 to 2022) versus CRRT alone (2013 to 2017) in managing children with dengue-associated acute liver failure and shock syndrome. Clinical and laboratory data were reviewed from PICU admission, before and 24 h after CRRT and TPE treatments. The main study outcomes were 28-day in-hospital mortality, hemodynamics, clinical hepatoencephalopathy, and liver function normalization. MEASUREMENTS AND MAIN RESULTS: A total of 34 children with a median age of 10 years (interquartile range: 7–11 yr) underwent standard-volume TPE and/or CRRT treatments. Combined TPE and CRRT (n = 19), versus CRRT alone (n = 15), was associated with lower proportion of mortality 7 of 19 (37%) versus 13 of 15 (87%), difference 50% (95% CI, 22–78; p < 0.01). Use of combined TPE and CRRT was associated with substantial advancements in clinical hepatoencephalopathy, liver transaminases, coagulation profiles, and blood lactate and ammonia levels (all p values < 0.001). CONCLUSIONS: In our experience of children with dengue-associated PALF and shock syndrome, combined use of TPE and CRRT, versus CRRT alone, is associated with better outcomes. Such combination intervention was associated with normalization of liver function, neurological status, and biochemistry. In our center we continue to use combined TPE and CRRT rather than CRRT alone.

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“…Disseminated intravascular coagulation (DIC), acute renal failure (ARF), shock due to the loss of vascular resistance, acute respiratory distress syndrome (ARDS), hepatic encephalopathy (HE), and sepsis-associated infection translocation often develop secondary to ALF. The severity of organ failure is linked to elevated and circulating cytokines and endotoxins, such as TNF-alpha, interleukin (IL)-6, IL-1ß, IL-8, IL-10, IL-2, IL-4, and IFN-γ (7)(8)(9). Although some patients with a high probability of death may recover with supportive treatment, emergency liver transplantation (LTX) still is the definitive treatment; however, the availability of suitable organs for LTX is limited.…”

Section: Introductionmentioning

confidence: 99%

Value of extracorporeal artificial liver support in pediatric acute liver failure: A single-center experience of over 10 years

Ocak

2023

Front. Pediatr.

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PurposeAcute liver failure (ALF) is a life-threatening disease characterized by rapid-onset liver dysfunction, coagulopathy, and encephalopathy in patients without chronic liver disease. Today, the combined application of continuous veno-venous hemodiafiltration (CVVHDF) and plasma exchange (PEX), which are forms of supportive extracorporeal therapy (SECT), with conventional liver therapy in ALF is recommended. This study aims to retrospectively analyze the effects of combined SECT in pediatric patients with ALF.Materials and MethodsWe retrospectively analyzed 42 pediatric patients, followed in the liver transplantation intensive care unit. The patients had ALF and received PEX supportive therapy with combined CVVHDF. The biochemical lab values of the results for the patients before the first combined SECT and after the last combined SECT were analyzed comparatively.ResultsOf the pediatric patients included in our study, 20 were girls and 22 were boys. Liver transplantation was performed in 22 patients, and 20 patients recovered without transplantation. After the discontinuation of combined SECT, all patients had significantly lower serum liver function test results (total bilirubin, alanine transaminase, aspartate transaminase), ammonia, and prothrombin time/international normalized ratio levels than the previous levels (p < 0.01). Hemodynamic parameters (i.e., mean arterial pressure) also improved significantly.Discussion and ConclusionCombined CVVHDF and PEX treatment significantly improved biochemical parameters and clinical findings, including encephalopathy, in pediatric patients with ALF. PEX therapy combined with CVVHDF is a proper supportive therapy for bridging or recovery.

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Therapeutic plasma exchange and continuous renal replacement therapy in pediatric dengue-associated acute liver failure: A case series from Vietnam

Cited by 12 publications

References 40 publications

Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome

Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome

Combined Therapeutic Plasma Exchange and Continuous Renal Replacement Therapy in Children With Dengue-Associated Acute Liver Failure and Shock Syndrome: Single-Center Cohort From Vietnam*

Value of extracorporeal artificial liver support in pediatric acute liver failure: A single-center experience of over 10 years

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