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Fulminant hepatic failure: etiology, viral markers and outcome

S V Bendre1, A R Bavdekar, S A Bhave

  • 1Department of Pediatrics, K.E.M. Hospital, Pune 411 011, India.

Indian Pediatrics
|April 4, 2000
PubMed

Insights

Viral hepatitis is the leading cause of pediatric fulminant hepatic failure (FHF). Hepatitis A virus (HAV) is frequently implicated, alone or in combination, with nearly half of all cases. Chronic liver disease can also manifest as FHF.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Infectious Diseases

Background:

  • Fulminant hepatic failure (FHF) in children presents a significant clinical challenge.
  • Understanding the diverse etiologies of pediatric FHF is crucial for timely diagnosis and management.
  • Viral hepatitis is a prominent cause of acute liver injury in pediatric populations.

Purpose of the Study:

  • To elucidate the etiological spectrum of fulminant hepatic failure (FHF) in pediatric patients.
  • To determine the outcomes associated with different causes of FHF in children.
  • To identify key clinical and biochemical predictors of poor outcomes in pediatric FHF.

Main Methods:

  • A hospital-based descriptive study was conducted over one year.
  • Thirty-six children aged 1.5 to 9 years with FHF were investigated.
  • Etiological workup included viral markers (HAV, HB, HCV, HEV), and tests for Wilson's disease, Indian Childhood Cirrhosis, and drug-induced hepatitis.

Main Results:

  • A viral etiology was identified in 61.1% of cases, with Hepatitis A virus (HAV) being the most common.
  • Hepatitis A alone or in combination accounted for approximately 50% of viral etiologies.
  • Mortality was 39%, with poor outcomes linked to bleeding, elevated prothrombin time, lower transaminases, and higher bilirubin levels upon admission.

Conclusions:

  • Viral hepatitis is the predominant cause of FHF in children, with HAV playing a significant role.
  • A definitive etiological diagnosis remains elusive in up to 22% of pediatric FHF cases.
  • Chronic liver diseases should be considered in the differential diagnosis of pediatric FHF.
Abstract

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