Related Experiment Videos
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.
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.
Objective:
To investigate the etiology and outcome of fulminant hepatic failure (FHF) in children.
Setting:
Hospital based descriptive.
Methods:
36 children (22 males and 14 females) presenting with FHF over a period of one year were investigated. The ages ranged from 1.5 to 9 years. FHF was defined as occurrence of encephalopathy within eight weeks of onset of jaundice with no evidence of pre-existing liver disease. Detailed history, clinical examination, routine biochemical parameters and relevant diagnostic tests were carried out. Viral markers studied were anti HAV-IgM, HBsAg, anti HBc-IgM, anti-HCV and anti HEV-IgM.
Results:
A viral etiology could be established in 22 children (61.1%). Hepatitis A (n = 12), Hepatitis B (n = 3), Hepatitis A and B (n = 2), and Hepatitis A and E (n = 4). Two children had enteric fever (1 with associated HEV), 2 children had Wilson's disease, 1 child had Indian Childhood Cirrhosis (ICC) and 2 children had drug induced hepatitis. Etiological diagnosis was not possible in 8 children (22%). Fourteen children (39%) died. Poor outcome was associated with spontaneous bleeding, raised prothrombin time, lower transaminases and higher bilirubin on admission.
Conclusion:
Viral hepatitis is the commonest cause of FHF in children. HAV alone or in combination is responsible for upto 50% of all FHF in children. Chronic liver disease can also present as FHF. Etiological diagnosis is not possible to upto one-fourth of all cases.