Incidence, predictors and outcome of sepsis-associated liver injury in children: a prospective observational study.

Abstract

Sepsis-associated liver injury (SALI) occurs as a result of the systemic and microcirculatory changes that happen because of sepsis. Its prognostic significance in the paediatric population is unclear. We enrolled all children < 19 years, admitted between July, 2020 and July, 2021 to the paediatric unit (ward or intensive care unit) with a diagnosis of sepsis for this study. Clinical and biochemical parameters of children with sepsis who developed SALI were compared with those without SALI to determine the risk factors of SALI and its impact on in-hospital mortality. A total of 127 children, median age 72 (1–204) months, 74 males were included. SALI developed in 45 (31.3%) at a median 1 (1–13) days after the diagnosis of sepsis. The SALI pattern was cholestatic in 18 (40%), hepatocellular in 17 (37.7%) and hypoxic hepatitis in 10 (22.3%). Paediatric sequential organ failure assessment (pSOFA) was an independent predictor of SALI — OR 1.17 (95% CI 1.067–1.302), p = 0.001. A pSOFA score of > 9.5 predicted the development of SALI with 66.7% sensitivity and 77.1% specificity. SALI was an independent predictor of mortality in children with sepsis — OR 1.9 (95% CI 1.3–3.4), p = 0.01. Conclusions: SALI develops in 45 (31.3%) with sepsis. A higher pSOFA score is associated with SALI. Children who develop SALI have a ~ twofold higher risk of mortality than those without SALI.What is Known:• During the process of sepsis, the liver plays a role by scavenging bacteria and producing inflammatory mediators. However, at times the liver itself becomes a target of the dysregulated inflammatory response. This is known as sepsis-associated liver injury (SALI).• The incidence of sepsis-associated liver injury and its prognostic significance in children is not known..What is New:• SALI develops in one-third children with sepsis and is associated with a higher pSOFA score.• Children who develop SALI have a higher risk of mortality. Supplementary informationThe online version contains supplementary material available at 10.1007/s00431-022-04374-2.