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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
Insights
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.
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.
Abstract:
OBJECTIVE: The objective of this study was to analyze the incidence and significance of hepatic dysfunction after cardiac surgery in children. DESIGN: Prospective, observational study. SETTING: Pediatric intensive care unit of a university hospital. PATIENTS: The study consisted of 232 children ranging in age from newborn to 17 years with no history of liver disease. MEASUREMENTS AND MAIN RESULTS: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyltranspeptidase (GGT), alkaline phosphatase, total and conjugated bilirubin, blood glucose, urea, creatinine, and coagulation studies were determined at admission, at 24 and 48 hrs, and at 7 days. Hepatic dysfunction was taken as an ALT of > 100 IU/L or a moderate or high hepatic score. The statistical study included bivariate analysis and multivariate logistic regression to study the risk factors for hepatic dysfunction. Twenty-one patients (9%) showed an ALT > 100 IU/L, and 29.3% had a moderate or high hepatic score. A relationship was found between hepatic dysfunction and the type of cardiopathy (D-transposition of the great arteries and coarctation of the aorta), shock, the administration of dopamine or epinephrine, renal insufficiency, the presence of pulmonary changes (pulmonary edema, atelectasis, pulmonary hypertension, hypoxemia), hematologic disturbances (prothrombin time, kaolin-cephalin time, fibrinogen, and platelets), and the need for a greater number of transfusions of packed cells, plasma, and platelets. Compared with 7.6% of the rest of the patients (p <.001), 38% of patients with an ALT > 100 IU/L died. The hepatic score of those patients who died was 4.2 (2.3)-higher than that of the survivors at 1.5 (1.8), (p <.001). Shock and renal insufficiency were the factors most significantly related to the development of hepatic dysfunction. CONCLUSIONS: Hepatic dysfunction is an uncommon complication in children after cardiac surgery. This complication is related mainly to hemodynamic disturbances and renal insufficiency and is an indicator of poor prognosis.
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