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Hepatic dysfunction after cardiac surgery in children.

P Vázquez1, J López-Herce, A Carrillo

  • 1Pediatric Intensive Care Unit (Drs. Vázquez, López-Herce, Carrillo, Sancho, and Bustinza), Preventive and Quality Control Service (Dr. Díaz), Gregorio Marañón, University General Hospital, Madrid, Spain

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 12, 2003
PubMed
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Hepatic dysfunction after pediatric cardiac surgery is uncommon but linked to poor outcomes. Hemodynamic instability and kidney problems are key risk factors, increasing mortality risk.

Area of Science:

  • Pediatric Cardiology
  • Hepatology
  • Critical Care Medicine

Background:

  • Cardiac surgery in children can lead to complications.
  • Understanding post-operative hepatic dysfunction is crucial for patient outcomes.

Purpose of the Study:

  • To determine the incidence and significance of hepatic dysfunction in pediatric patients following cardiac surgery.
  • To identify risk factors associated with hepatic dysfunction in this population.

Main Methods:

  • Prospective, observational study in a pediatric intensive care unit.
  • Involved 232 children (newborn to 17 years) without prior liver disease.
  • Monitored liver function tests (ALT, AST, GGT, bilirubin), glucose, renal function, and coagulation parameters.

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Main Results:

  • 9% of patients had elevated alanine aminotransferase (ALT) (> 100 IU/L); 29.3% had a moderate or high hepatic score.
  • Hepatic dysfunction correlated with specific heart conditions, shock, certain medications (dopamine, epinephrine), renal insufficiency, pulmonary issues, and hematologic disturbances.
  • Mortality was significantly higher (38%) in patients with ALT > 100 IU/L compared to others (7.6%).
  • Shock and renal insufficiency were the strongest predictors of hepatic dysfunction.

Conclusions:

  • Hepatic dysfunction is an infrequent but serious complication after pediatric cardiac surgery.
  • The primary drivers of hepatic dysfunction are hemodynamic instability and concurrent renal insufficiency.
  • This complication serves as a significant indicator of a poor prognosis in pediatric cardiac surgery patients.