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Secondary Hepatic Injury in Pediatric Intensive Care: Risk Factors and Prognostic Impact

Joana Direito1, Carla Fernandes2, Rita G Branquinho1

  • 1Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Coimbra.

Journal of Pediatric Gastroenterology and Nutrition
|June 12, 2021
PubMed

Insights

Secondary hepatic injury (SHI) affects 16.5% of pediatric intensive care patients and is linked to worse outcomes. Alanine aminotransferase (ALT) is a key predictor of mortality in these critically ill children.

Area of Science:

  • Pediatric critical care medicine
  • Hepatology
  • Clinical research

Background:

  • Secondary hepatic injury (SHI) is a significant concern in pediatric intensive care.
  • Understanding the risk factors and prognostic implications of SHI is crucial for improving patient outcomes.

Purpose of the Study:

  • To characterize the occurrence and patterns of SHI in pediatric intensive care patients.
  • To identify independent risk factors associated with different SHI patterns.
  • To evaluate the impact of SHI on patient prognosis and mortality.

Main Methods:

  • An exploratory, observational, and retrospective study design was employed.
  • Patients were categorized into groups with and without SHI based on specific liver enzyme and bilirubin levels.
  • SHI patterns were classified as cytolysis, cholestasis, or mixed.

Main Results:

  • SHI was observed in 16.5% of patients, with cytolysis, cholestasis, and mixed patterns occurring in 5%, 4%, and 7%, respectively.
  • Risk factors varied by SHI pattern, including organ dysfunction scores, parenteral nutrition, comorbidities, and sepsis.
  • Alanine aminotransferase (ALT) emerged as an independent risk factor and a strong predictor of mortality (AUC=0.865).

Conclusions:

  • SHI is associated with a poorer prognosis in pediatric intensive care settings.
  • ALT levels may serve as a valuable surrogate marker for illness severity and an indicator of increased mortality risk.
Abstract

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