ABSTRACT 245

Abstract

Background and aims: Acute liver failure (ALF) in children is a rare but potentially fatal disease. The etiology of ALF varies in developing countries. Aims: To study clinical profile of children with acute liver failure (ALF) with relation to demographics, etiology and outcome. Methods: A retrospective study collecting demographic, clinical, laboratory, and short-term outcome data on children (1 month to 18 years) diagnosed as ALF admitted in PICU between January 2003 and September 2012. Results: 85 children were diagnosed with ALF. Mean age of presentation was 6 + 4.4yrs with male: female: 1.2:1. 9 children were <1yr, 27 were between 1–5 yr and 49 were >5 yrs.The cause of ALF included hepato tropic viral infections 24.7%, indeterminate 24.7%, sepsis induced liver dysfunction 25.9%, ALF due to dengue fever was 9.4%, drug-induced hepato toxicity 7.1% and wilson’s disease 4.7%. Jaundice was present in all patients and 85% had features of encephalopathy. 56.4% had gastrointestinal bleeding, 60% requiring mechanical ventilation and 50% required inotropic support. Survival rate was only (37/85) 43.5% and 56.5% died. Children with viral hepatitis showed good outcome (16/21) as compared with alf due to other causes. PELD score among survivor was greater than non survivors (39 +15 vs 29+13.7) with p=0.01.Children with grade 3 [13/8(61%)] and grade 4 [13(100%)] had highest mortality. Majority of death were observed in children <1 yr 66.6%followed by 57.1% in >5 yr and 51.8% in 1–5 yr. Conclusions: The etiology of fulminant liver failure differs in children from adults. An equal percentage of children with ALF had viral hepatitis and inderminate cause as primary etiology. Infants experienced higher mortality.