Acute Liver Failure in Children: Clinical Presentation and Management

Abstract

Introduction: Acute liver failure (ALF) is an uncommon condition in which rapid deterioration of liver functions results in coagulopathy, usually with an international randomized ratio (INR) of greater than 1.5 which is not corrected by a single dose of vitamin K, the condition associated with encephalopathy or INR 2 or more and is not corrected by a single dose of vitamin K without encephalopathy. Acute liver failure (ALF) is a life-threatening condition characterized by jaundice, encephalopathy and coagulopathy leading to multi-organ failure in a patient with no prior history of liver disease and carries a very high mortality rate. Objective: To study the clinical presentation and management of acute liver failure (ALF) among children admitted to Jaffer Ibn Oaf Teaching Hospital in Khartoum, Sudan during the year 2019. Methods: A descriptive cross sectional and hospital-based study conducted in all children presented to Jaffer Ibn Oaf Teaching Hospital in Khartoum, Sudan with acute liver failure during January to December 2019. The study sample was calculated by total coverage of all patients. Study questionnaires captured mainly quantitative data. The data was reviewed and analyzed into descriptive and inferential statistics by using computerized software package for window statistical package for social science (SPSS) version 21. Results: 47 children had acute liver failure were included. The prevalence of pediatric ALF in the studied hospital was 8.95%. The majority of participants were males and were 2 months to 14 years of age. All patients (100%) presented with jaundice, 38 (80.9%) had weakness and fatigue, 23 (48.9%) developed encephalopathy, mainly grade-I, 19 (40.0%) had nausea, 16 (34%) had ascites and 7 (14.8%) had seizures. INR was prolonged in all patients. Most patients had abnormal liver function tests. Almost all patient received vitamin K injection. Many patients needed pressure and circulation support and special treatment based on the underline cause. The mortality rate was 34% and 29.8% of the patients were recovered without liver transplantation. Statistically significant best outcome associated with elder age and hepatic encephalopathy grade-1. Poor outcome was significantly frequent among patients with anemia, thrombocytopenia, leukocytosis, hypokalemia and high liver enzymes. Conclusion: Pediatric acute liver failure mainly presented with jaundice, weakness and fatigue, grade-I encephalopathy, nausea, ascites and seizures. Treatment was mainly supportive with some patient needed treatment for the underlying causes. Poor outcome associated with anemia, thrombocytopenia, leukocytosis, hypokalemia and high liver enzymes.