Shweta Dixit
Sir Gangaram Hospital, India
Title: The Etiology outcome and prognostic indicators in children with acute hepatic failure
Biography
Biography: Shweta Dixit
Abstract
Objective: To study the etiology, outcome and prognostic indicators in pediatric acute liver failure (ALF).
Material & Method: A retrospective analysis of patients with ALF between 2010 and 2018 was performed. There were total 90 patients. Patients who survived with supportive therapy were designated as Group 1, while those who died or required liver transplantation were designated as Group 2.
Results: There were 90 children- 64 male, 26 females, median age eight years; range, one month-17 years were identified with fulminant hepatic failure. In Group 1 there were 53 (58.9%) patients and 37 (41.1%) patients in Group 2. The overall survival rate was 74%. Eleven (11) patients (12.2%) underwent liver transplantation, all are alive and well. The etiologies were: 60 (67%) infectious, 5 (5.5%) drug-induced, 5 (5.5%) Wilson disease and 3 (3.3%) autoimmune hepatitis. Overall acute viral hepatitis A is the most common cause. There were 16 (17.8%) cases which were of indeterminate etiology. Group 2 children had higher plasma bilirubin (median, 18.4 mg/dl versus 8.8 mg/dl), higher prothrombin time (median, 50.3 seconds versus 31.7 seconds) higher international normalized ratio (INR) (median, 4.9 vs 2.9) lower alanine aminotransferase (median, 1128 IU/L versus 2211 IU/L) and lower aspartate aminotransferase (median, 640 IU/L versus 1839 IU/L) levels on admission (P<0.005). Using receiver operating characteristic curves the cutoff values as predictor of the eventual failure of conservative therapy were serum bilirubin >13.6 mg/dl, prothrombin time >35.8 sec, INR >3.7, alanine aminotransferase ≤1913 IU/L, aspartate aminotransferase ≤ 1744 IU/L on admission.
Conclusions: Pediatric acute liver failure patients with high bilirubin, severe coagulopathy, lower alanine aminotransferase and lower aspartate aminotransferase level on admission are more likely to have poor prognosis. Early consideration of liver transplantation is of paramount importance in these patients.