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Predictors of outcome in fulminant hepatic failure in children
K L Srivastava1, A Mittal, A Kumar
1Department of Pediatrics, King George's Medical College, Lucknow.
Insights
Gastrointestinal hemorrhage, coma grade, and high serum bilirubin predict mortality in pediatric fulminant hepatic failure (FHF). Early identification of these factors is crucial for improving outcomes in children with FHF.
Area of Science:
- Pediatric Hepatology
- Critical Care Medicine
- Clinical Epidemiology
Background:
- Fulminant hepatic failure (FHF) in children is a critical condition with high mortality.
- Identifying prognostic factors is essential for timely intervention and management.
Purpose of the Study:
- To determine the predictors of outcome in pediatric patients diagnosed with FHF.
- To identify independent factors associated with mortality in this vulnerable population.
Main Methods:
- A prospective cohort study involving 41 children with FHF.
- Data collected included patient characteristics, clinical findings, and laboratory tests.
- Univariate and multivariate logistic regression analyses were performed to identify outcome predictors.
Main Results:
- The most common cause of FHF was Hepatitis B (26.9%).
- Overall mortality was 61%.
- Independent predictors of mortality identified by multivariate analysis were gastrointestinal hemorrhage, degree of coma, and serum bilirubin level.
Conclusions:
- Gastrointestinal hemorrhage, coma grade, and elevated serum bilirubin are significant independent predictors of mortality in pediatric FHF.
- These findings can aid in risk stratification and clinical decision-making for children with FHF.
Objective:
To identify the predictors of outcome in fulminant hepatic failure (FHF) in children.
Study Design:
Prospective cohort study.
Methods:
41 children with FHF were studied. Patient characteristics and findings on examination at the time of hospitalization were noted. Serum biochemistry and screening for hepatotropic viruses (A, B and C) were done in each patient. Patients were treated using a predefined protocol and followed up till death or discharge. Univariate and multivariate analysis was done to find the predictors of outcome.
Results:
Hepatitis B was the commonest cause of FHF (11 children; 26.9%). Markers for hepatitis A and C viruses were present in one and two patients, respectively. Serology was negative in 27 children (65.9%), of whom two had history of ingestion of hepatotoxins (antitubercular drugs). The overall mortality was 61%. Irrespective of etiology, the following factors were associated with poor outcome on univariate analysis: presence of gastrointestinal (GI) hemorrhage, serum bilirubin more than 10 mg/dL, age 6 years or less, coma of grade 3 or more, presence of infection, prolongation of prothrombin time > 8 s over control, prothrombin concentration < 50%, hypoglycemia (blood glucose < 45 mg/dL), hyponatremia (serum sodium < 125 mEq/L) and hyperkalemia (serum potassium > 5.5 mEq/L). On multiple logistic regression analysis, presence of GI hemorrhage (p = 0.005), degree of coma (p = 0.02) and serum bilirubin level (p = 0.025) were identified as independent predictors of mortality.