Risk Factors of Mortality in Children with Hepatic Encephalopathy

Abstract

Background: Hepatic encephalopathy is a serious but potentially reversible complication in children with liver disease. The aim of this study is to evaluate the risk factors of mortality in children with hepatic encephalopathy. Method: Totally 42 patients including 22 boys and 20 girls with clinical diagnosis of hepatic encephalopathy who admitted to Pediatric Intensive Care Unit at Nemazee Hospital affiliated to Shiraz University of Medical Sciences, during 5 years period were enrolled in this study. Demographic features, cause of hepatic failure, grade of hepatic encephalopathy, predisposing factors, concurrent clinical manifestations and laboratory data, as possible prognostic factors were evaluated. The survival states of the patients (survivors or non-survivors) as final outcome were also documented. Results: The most common underlying liver diseases were cryptogenic (57.2%), hepatitis A (23.8%), Wilson disease (7.1%), and autoimmune hepatitis (7.1%). The total mortality rate was 54%. There was no statistically significant difference in age, weight and hospital stay between survivors or non-survivors groups. Only gastrointestinal bleeding had significant association with mortality (37% vs 92%; p=0.001). The most common predisposing factor was infection (52.5%). Patients with higher international normalized ratio and partial thromboplastin time and lower serum sodium and bicarbonate on admission and those with higher bilirubin, international normalized ratio, partial thromboplastin time, aspartate aminotransferase and lower platelets and serum bicarbonate level on last day were more likely to die. Conclusion: Poor prognostic factors for hepatic encephalopathy were included gastrointestinal bleeding, higher international normalized ratio, partial thromboplastin time, bilirubin, and aspartate aminotransferase, and lower serum sodium and bicarbonate levels and platelet counts.