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Prevalence and Precipitants of Hepatic Encephalopathy in Hospitalized Children With Chronic Liver Disease
Aathira Ravindranath1, Anshu Srivastava1, Surender K Yachha1
1Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
Hepatic encephalopathy (HE) affects one-third of children with chronic liver disease (CLD), often triggered by infections. Children with HE experience worse liver function and poorer outcomes, highlighting the need for timely intervention.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Medicine
Background:
- Hepatic encephalopathy (HE) is a significant indicator of poor prognosis in adults with chronic liver disease (CLD).
- Limited literature exists on the prevalence and triggers of HE specifically in pediatric populations with CLD.
Purpose of the Study:
- To prospectively investigate the prevalence and identify the precipitants of hepatic encephalopathy (HE) in children diagnosed with chronic liver disease (CLD).
Main Methods:
- Prospective study involving 160 children (1-18 years) admitted with CLD.
- Daily assessment for HE presence and grading using West Haven/Whittington criteria.
- Classification of precipitants including infection, dyselectrolytemia, GI bleeding, constipation, and dehydration.
Main Results:
- HE was identified in 50 (31.2%) children, with 61 total episodes.
- Infection (73.7%) and dyselectrolytemia (54%) were the most frequent precipitants.
- Children with HE exhibited poorer liver function (lower albumin, sodium; higher INR) and significantly worse in-hospital and 1-month post-discharge mortality rates compared to those without HE.
Conclusions:
- Approximately one-third of pediatric patients with CLD experience hepatic encephalopathy (HE).
- Identifiable precipitants, primarily infections, were present in 90% of HE episodes.
- HE in children with CLD is associated with compromised liver function and poorer clinical outcomes.
Objective:
Hepatic encephalopathy (HE) is a marker of poor prognosis in adults with chronic liver disease (CLD). We prospectively studied the prevalence and precipitants of HE in children with CLD as there is a paucity of literature on the same.
Methods:
Children (1-18 years) admitted with CLD were examined daily for the presence and grading of HE (West Haven/Whittington grading). Precipitants were classified as infection, dyselectrolytemia, gastrointestinal bleeding, constipation and dehydration. Changes in grades of HE and outcome were noted.
Results:
One hundred and sixty children (age 120 [84-168] months) were enrolled. HE was present in 50 (31.2%) patients with a total of 61 episodes. Maximum grade of HE was grade I (n = 16), II (n = 23), III (n = 11) and IV (n = 11). Forty-two cases had single and 8 had recurrent (2-5) episodes. Median duration of HE episodes was 96 (72-192) hours. Precipitants were identified in 55/61 (90.2%) episodes with infection (45/61, 73.7%) and dyselectrolytemia (33/61, 54%) being the most common. Lower albumin and sodium, higher INR and presence of infection were significantly associated with presence of HE. Overall, HE resolved in 33 (54%) episodes, while it progressed and persisted in 28 (45.9%) episodes. Patients with HE had a poorer outcome (25/50 vs 13/110; P < 0.01) with both higher in-hospital (11/50 vs 9/110; P = 0.02) and 1-month post discharge (14/39 vs 4/101; P < 0.01) mortality than those without HE.
Conclusion:
One-third of admitted CLD children have HE, with identifiable precipitants in 90% of cases. Children with HE have poorer liver functions, higher rate of infections and worse outcome than those without HE.
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