Abstract
BackgroundAcute liver failure (ALF) is marked by a sudden loss of hepatic function and is associated with a high mortality rate in children. The etiology of ALF is shown to vary geographically. This study assessed the frequency of hepatotropic viruses as etiological agents of ALF in Indian children.MethodsThis retrospective study enrolled children aged 0–18 years with confirmed ALF admitted to Christian Medical College, Vellore and King Edward Memorial Hospital and Research Center, Pune between January 2003 and December 2005. The frequency of hepatotropic viruses as etiological agents in children with ALF aged ≤18 years was calculated with 95 % confidence interval (CI). Descriptive analyses of demographic characteristics, clinical signs and symptoms of ALF, choice of treatment and outcomes were performed.ResultsOf 76 children enrolled, 54 were included in the per-protocol analyses. Mean age of children with ALF was 5.43 years (standard deviation = 3.62); 51.9 % (28/54) were female. The percentage of children positive for anti-hepatitis A virus (HAV) IgM and hepatitis B surface antigen was 65.9 % (27/41; 95 % CI 49.4–79.9) and 15.9 % (7/44; 95 % CI 6.6–30.1), respectively. The final cause of ALF was HAV (36.3 %) followed by hepatitis B virus (HBV; 8.8 %). Before and during admission, encephalopathy was observed in 77.8 % (42/54) and 63.0 % (34/54) of children, respectively. A high number of children (46/54; 85.2 %) required intensive care and ALF was fatal in 24.1 % (13/54). The proportion of deaths due to HAV and HBV was 18.5 % (5/27) and 57.1 % (4/7), respectively.ConclusionsHAV and HBV were the most common etiological agents of ALF in Indian children. Primary prevention by vaccination against HAV and HBV in young children may be useful in the prevention of ALF due to viral hepatitis in India.
Highlights
Acute liver failure (ALF) is marked by a sudden loss of hepatic function and is associated with a high mortality rate in children
Acute liver failure (ALF) is a rare clinical syndrome marked by the sudden loss of hepatic function and a potentially fatal disease associated with a high mortality rate in children [1]
Demography A total of 76 children were enrolled into the study, of which 22 children were eliminated from the per-protocol analyses for protocol violation with respect to inclusion/ exclusion criteria (n = 17) and for having an underlying medical condition not specified by the inclusion criteria (n = 5)
Summary
Acute liver failure (ALF) is marked by a sudden loss of hepatic function and is associated with a high mortality rate in children. This study assessed the frequency of hepatotropic viruses as etiological agents of ALF in Indian children. Acute liver failure (ALF) is a rare clinical syndrome marked by the sudden loss of hepatic function and a potentially fatal disease associated with a high mortality rate in children [1]. This study assessed the frequency of hepatotropic viruses as etiological agents and outcomes of ALF in medical institutions located in two diverse parts of India—centers in southern and western India using for the first time a similar methodology at both centers
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