P0264 RISK FACTORS PREDICTING MORTALITY IN FULMINANT HEPATIC FAILURE IN CHILDREN ??? 17 YEARS RETROSPECTIVE ANALYSIS

Abstract

Introduction: Spontaneous recovery of fulminant hepatic failure (FHF) remains unpredictable, especially in children. The successful use of orthotopic liver transplantation in FHF has created a need for early prognostic indicators to select the patients most likely to benefit at a time when liver transplantation is still feasible. Methods: We retrospectively reviewed the medical records of all 38 pediatric patients under 18 years old presenting with FHF who were seen and admitted from January 1986 to December 2002 to Children’s Hospital of Cheng-Gung Medical Center in Kaohsiung, Taiwan. The patients were subdivided into two groups by whether they later died or not and were further analyzed by comparing their demographic data, past or personal history, biochemical parameters at admission and the initial time when encephalopathy occurred, clinical manifestations, ultrasonographic findings, and hospital course to access the predicting factors for mortality in FHF children. Statistical tools used to compare variables between groups were Students t-test and chi-square test. Values were expressed as mean(??′SD) and P<0.05 was considered significant. Results: Mean age of the 38 patients was 4.22(±5.49) years old (range: 5 days to 17 years old). Males are more predominant than females (24 v.s. 14). Viral hepatitis revealed the commonest etiology where viral agent(s) other than hepatitis A to D corresponded the most common (23.1%). The mortality rate was 55.3%(21 of 38 patients dead). Non-survivors had significantly higher WBC (17460±10440/cm2 v.s. 11040±4460/cm2), lower GPT (934.22±1637.19 U/L v.s. 2994.60±2413.59 U/L), higher direct (10.18±6.47 mg/dl v.s. 5.19±3.69 mg/dl) and total bilirubin (25.17±14.89 mg/dl v.s. 9.89±7.41 mg/dl) at the day when encephalopathy occurred, longer time interval between the onset of jaundice and encephalopathy (11.75±8.20 days v.s. 1.50±0.71 days), and higher incidence of splenomegaly and transfusion than the survivors (P<0.05). Conclusion: Our study provides the clues for predicting the mortality of FHF in pediatric patients at the onset of encephalopathy that were rarely mentioned in children before. This prediction is valuable because it may be useful to reverse the unfavorable outcome with appropriate therapy, including intensive management and emergent orthotopic liver transplantation, in early stage.