Liver Function In Children Research Articles

Effects of obesity on liver function in children

Effects of obesity on liver function in children

Results of treatment of diffuse purulent peritonitis in children

BACKGROUND: Despite significant achievements in surgery and in antibiotic therapy, management of children with severe purulent complications of surgical diseases in the abdominal cavity remains an important issue. Due to the polyetiology of diffuse purulent peritonitis, sometimes not enough attention is paid to metabolism correction, especially in children. Optimization of comprehensive therapy in the diffuse purulent peritonitis promotes better outcomes in this group of patients. AIM: To assess results of the treatment of children with diffuse purulent peritonitis applying the optimized pathogenetic therapy which includes a differentiated approach to the preoperative preparation, active correction of dysmetabolic disorders in the postoperative period as well as selection of the criteria for abdominal cavity sanation bearing in mind the degree of intra-abdominal hypertension. METHODS: Outcomes of 339 patients, aged 1–14 years, with diffuse peritonitis of various etiology were analyzed. The patients were hospitalized to pediatric surgical departments in Samara in 2006–2022. The studied group included 237 children with diffuse purulent peritonitis who were prescribed the optimized comprehensive therapy. Control group included 102 children with diffuse purulent peritonitis who were prescribed traditional therapy according to the generally accepted standards. In the studied group, patients' therapeutic tactics included a therapeutic and diagnostic algorithm developed by the authors. Complex examination registered the dynamics of biochemical blood parameters: total protein, albumin, alanine transaminase, aspartate aminotransferase, as well as indicators of endotoxicosis (C-reactive protein and procalcitonin). RESULTS: After studying the dynamics of transaminases, we concluded that in children with widespread peritonitis in the main group, despite the initial severity of endotoxicosis, there was a faster decrease in the level of liver enzymes, indicating a more effective restoration of cell membranes. The dynamics of the level of total protein and albumin revealed a faster recovery of protein-synthetic liver function in children of the main group, including antitoxic, which was reflected in the improvement of the general condition of patients and stabilization of hemostasis indicators, a decrease in the levels of acute phase proteins. The analysis of the results of the complex treatment of children with advanced peritonitis revealed a statistically significant decrease in the main group: the duration of stay of patients in the intensive care unit after surgery, the timing of infusion therapy in the postoperative period, as well as the duration of hospitalization. CONCLUSION: Thus, less stay in the intensive care unit in the postoperative period, less terms of infusion therapy as well as less length of stay in children with diffuse peritonitis demonstrate better effectiveness of the proposed comprehensive management of children with the discussed pathology.

The Impact of G6PD Deficiency on Liver Function in Children Under 15

Glucose-6-phosphate dehydrogenase (G6PD) is involved in the first phase of the pentose phosphate pathway (PPP), entailing the reduction of nicotinamide adenine dinucleotide phosphate (NADP+) and the oxidation of glucose-6-phosphate to 6-phosphogluconolactone. A deficiency in the G6PD activity can result in numerous illnesses, including liver diseases. The first three enzymes in PPP are responsible for the oxidative phase. They make NADPH, which is needed to deal with oxidative stress, especially in people who do not have enough G6PD. The study included (90) samples from people with hemolytic anemia (Favzim) and control to determine the levels of G6PD, albumin, total protein, liver function, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and bilirubin. The results showed that there was a significant decrease (P<0.05) in the serum levels of G6PD in the patients group when compared with the control group. Also, there was a significant increase (P<0.05) in the serum levels of albumin, total protein, ALP, ALT, AST and total bilirubin in patients with the G6PD deficiency when compared with the control group. In addition, this study revealed a strong positive correlation between some biochemical parameters studied, such as: Total protein with TSB (r2 = 0.897), TSB with ALT (r2 = 0.893), AST with ALT (r2 = 0.623) and total protein with ALT (r2 = 0.804).

The Effect of Malaria Disease on Liver Function in Children Below 5 Years of Age

Malaria continues to be a major global health concern in tropical regions, especially affecting children between the ages of 1 and 5. The aim of this study is to assess the influence of malaria on hepatocellular function in this vulnerable age group. The enrollment of 582 randomly selected children was approved ethically, and parental consent was obtained. Of these, 396 were in the test group (who tested positive for malaria), and 186 were in the control group (apparently healthy). Giemsa-stained thin and thick films were used to confirm the diagnosis of malaria, and serum markers such as SGOT, SGPT, ALP, and gamma glutamyl transferase were used to assess hepatocellular function while the malaria diagnosis was made. As further markers of liver health, albumin and protein levels were evaluated. The findings showed that, in comparison to the control group, children with malaria parasitemia had statistical significantly higher levels of ALP, SGOT, SGPT, and Gamma Glutamyl Transferase as well as lower levels of total protein and albumin (p < 0.05). This suggests a significant effect on liver function in children with malaria, ages 1 to 5. Finally, our research highlights the connection between liver impairment in young children and malaria parasitemia. To improve early detection and management of liver-related complications in affected children, we recommend adding hepatic function assessments to routine evaluations, especially in malaria-endemic areas.

Abnormal liver function in children hospitalized with acute respiratory infection of adenoviruses: a retrospective study.

Human adenoviruses (HAdVs) can cause acute hepatitis in immunocompromised patients. However, it is unclear whether HAdVs are contributors to hepatitis in immunocompetent children. In this study, the liver function test (LFT) results were retrospectively analyzed among children hospitalized (age < 14 years) between January 2016 and October 2019 for acute respiratory infection caused by adenoviruses. Alanine transaminase (ALT) and aspartate aminotransferase (AST) levels were elevated in 7.74% and 46.89% of patients, respectively. All patients with > 2 folds of the upper limit of ALT or AST levels were infected with HAdV-7 or HAdV-55. Significantly higher levels of ALT, AST, γ-glutamyl transpeptidase (γ-GT), and lower albumin levels were observed in the HAdV-7 infection group than in the HAdV-3 infection group. HAdV-55 infection led to significantly higher γ-GT, total bilirubin, and direct bilirubin levels than the other infection types. The records of four patients with serial monitoring of the LFT results were further analyzed. Multiple indicators remained abnormal during the entirehospitalization in these patients. These results indicate that HAdV infection is often accompanied by abnormal liver function, and HAdV-7 and HAdV-55 might be under-recognized contributors to hepatitis among children.

Abnormal liver function in children hospitalized with acute respiratory infection of adenoviruses: a retrospective study

Human adenoviruses (HAdVs) can cause acute hepatitis in immunocompromised patients. However, it is unclear whether HAdVs are contributors to hepatitis in immunocompetent children. In this study, the liver function test (LFT) results were retrospectively analyzed among children hospitalized (age <14 years) between January 2016 and October 2019 for acute respiratory infection caused by adenoviruses. Alanine transaminase (ALT) and aspartate aminotransferase (AST) levels were elevated in 7.74% and 46.89% of patients, respectively. All patients with >2 folds of the upper limit of ALT or AST levels were infected with HAdV-7 or HAdV-55. Significantly higher levels of ALT, AST, γ-glutamyl transpeptidase (γ-GT), and lower albumin levels were observed in the HAdV-7 infection group than in the HAdV-3 infection group. HAdV-55 infection led to significantly higher γ-GT, total bilirubin, and direct bilirubin levels than the other infection types. The records of four patients with serial monitoring of the LFT results were further analyzed. Multiple indicators remained abnormal during the entire hospitalization in these patients. These results indicate that HAdV infection is often accompanied by abnormal liver function, and HAdV-7 and HAdV-55 might be under-recognized contributors to hepatitis among children.

Application of a low copper diet guidance based on food exchange portions in children with hepatolenticular degeneration

To study the efficacy of a low-copper diet guidance based on food exchange portions in children with hepatolenticular degeneration. A self-controlled study was conducted from July 2021 to June 2022, including 30 children under the age of 18 who were diagnosed with hepatolenticular degeneration and poorly controlled with a low-copper diet. During the medical visit, personalized low-copper diet guidance was provided to the children and their parents using a copper-containing food exchange table and a copper food exchange chart. During home care, compliance with the low-copper diet of the children was improved by recording dietary diaries and conducting regular follow-ups. The changes in 24-hour urine copper level, liver function indicators, and the low-copper diet knowledge of the children's parents were observed before and after the intervention, with no change in the original drug treatment. After 8, 16, and 24 weeks of intervention, the 24-hour urine copper level decreased significantly compared to before intervention (P<0.05). When compared to 8-week intervention, the urine copper level decreased significantly after 16 and 24 weeks of intervention. The 24-hour urine copper level after 24 weeks of intervention decreased significantly compared to 16 weeks of intervention (P<0.05).After 24 weeks of intervention, the alanine aminotransferase and aspartate aminotransferase levels decreased significantly compared to before intervention (P<0.05). Additionally, in 16 of the cases (53%), alanine aminotransferase and aspartate aminotransferase returned to normal levels. Following 8 weeks of intervention, the low-copper diet knowledge of the children's parents increased significantly (P<0.05). A low-copper diet guidance based on food exchange portions can effectively decrease the urine copper level and improve liver function in children with hepatolenticular degeneration. Furthermore, it can increase the low-copper diet knowledge of the children's parents.

P303 Real-life data for liver function in children on CFTR-modulators in Bulgaria

Treatment aimed at correcting a specific gene mutation is a completely new approach for CF patients, which is mainly based on the so-called cystic fibrosis protein modulators (CFTR-modulators). These medications have been administered since the end of 2019 to CF patients in Bulgaria as well. Particular attention is directed to liver function in patients on CFTRm, as this may be the limiting factor for these medications.

A Randomized, Controlled Study Evaluating the Effects of Silymarin Addition to Deferasirox on the Liver Function of Children with Transfusion-Dependent Thalassemia

Background: Frequent blood transfusion can lead to iron overload which is potentially dangerous for the heart and liver. Silymarin has well-documented protective effects on hepatocytes. The purpose of this study was to evaluate the hepatoprotective effects of silymarin addition to iron chelators in children with thalassemia. Materials and Methods: This randomized, double-blinded, and placebo-controlled trial was performed on 40 subjects with thalassemia major and intermedia in Amir Kabir Hospital, Arak, Iran. Subjects were randomized 1:1 oral to 30 mg/kg deferasirox plus placebo, or deferasirox plus oral 70-140 mg silymarin (twice daily) for 6 months. Cardiac and hepatic iron levels and levels of Gamma-glutamyltransferase (GGT), Alanine transaminase (ALT), Aspartate transaminase (AST), Alkaline phosphatase (ALP), total bilirubin, albumin, total protein, and total cholesterol were measured at baseline and after 6 months of treatment. Results: The mean age of patients was 16 years and 60% of patients were female. After 6 months, there were significant increases in the levels of ALT, AST, GGT, and TG in the placebo group as compared to the silymarin group (P &lt; 0.05). In contrast, ALT, AST, and GGT had significant reductions compared to the silymarin group (P =0.05). Patients in the placebo group had a rise in total bilirubin (P = 0.07), but total protein and albumin did not have significant changes in the silymarin group (P &gt; 0.05). Finally, a significant improvement was noted in cardiac iron values in patients using silymarin; 22.2 ± 6.6 ms at baseline vs 26.9 ± 7.1 ms at 6 months (P &lt; 0.05). Conclusion: This study suggests that twice-daily addition of silymarin to deferasirox could improve liver function in children with thalassemia major and intermedia. Silymarin seems safe in pediatrics.

Cardiorespiratory Fitness Associates with Blood Pressure and Metabolic Health of Children-The Arkansas Active Kids Study.

High blood pressure (HBP) in children causes preclinical damage to the heart and accelerates atherosclerosis. Current pharmacological treatments have limited ability to prevent end-organ damage, particularly that of the kidneys. A contrasting element between adult versus pediatric HPB treatment is the emphasis in adults on exercise regimens that target increments in cardiorespiratory fitness (CRF; peak oxygen consumption [V˙O2peak]). The aim of this study was to evaluate the association of CRF with blood pressure percentiles and blood pressure status in children with normal and excessive adiposity (NA vs EA). An exploratory aim was to measure associations of CRF with (a) other cardiovascular disease risk factors commonly found in children with HBP and (b) kidney function. Children (n = 211) attended one study visit. CRF was measured using an incremental bike test and body composition by dual-energy x-ray absorptiometry. Fat-free mass (FFM) index was calculated as kilograms of FFM per square meter. Multiple logistic and linear regression analyses were used to model the probability of HBP and other variables of interest (plasma lipids, HOMA2-IR, alanine aminotransferase, and estimated glomerular filtration rate) against V˙O2peak. CRF interacted with adiposity status in predicting the probability of HBP. Each additional milliliter per minute per FFM index in V˙O2peak decreased the odds of HBP by 8% in the EA group only (odds ratio = 0.92, 95% confidence interval = 0.87-0.99). Systolic and diastolic blood pressure percentiles decreased, and estimated glomerular filtration rate increased with increasing CRF in both adiposity-level groups. HOMA2-IR and alanine aminotransferase decreased with increasing CRF in children with EA only. Higher CRF associated with decreased probability of clinical HBP, lower insulin resistance, and improved liver function in children with EA. Yet blood pressure percentiles and kidney function improved with increasing CRF irrespective of adiposity status.

The Correlation Between Serum Ferritin and Liver Function in Children with Thalassemia Mayor

Background: Iron overload in thalassemia major patients required regular blood transfusions due to ineffective erythropoiesis. Iron overload is a common chronic complication caused by increased iron absorption. Iron in the body will bind to ferritin. As the main iron storage in the body is in the liver, the iron overload will cause liver damage that reflects in high Serum Glutamic Oxaloacetic Transaminase (SGOT) and Serum Glutamic Pyruvic Transaminase (SGPT) level. This study will describe the relationship between serum ferritin and Serum SGOT and SGPT level so that it can be used as a marker of high iron levels in the body. Methods: This was an observational analytic study with a cross-sectional design which carried out in the Hemato-Oncology Division of H. Adam Malik Hospital Medan November ? December 2019. A total of 30 thalassemia major patients who were fulfilled the inclusions criteria were taken by consecutive sampling and were tested for serum ferritin, SGOT, and SGPT level. Results: Of the 30 samples, 43.3% of the subjects were male and 46.7% of the children suffering from malnutrition. The median number of transfusions was 93 times (40 - 202), the mean serum ferritin level was 1422 mcg / L (285 - 3441), the mean SGOT level was 35 U / L (11 - 167), and the mean SGPT level was 28 U / L (6 - 268). The relationship between the number of transfusions and ferritin levels, SGOT and SGPT level were r 0.102; p: 0.592, r 0.162; p: 0.932, r 0.134; p 0.481. In addition, the relationship between serum ferritin levels and SGOT and SGPT were r 0.285; p 0.127, r 0.274; p 0.142, respectively. Conclusion: There was no relationship between serum ferritin and liver function in thalassemia major.

Effect of Chemotherapy on Liver Function During Induction of Remission in Children with Acute Lymphoblastic Leukemia Receiving Standard Protocol

Objective: The present study was undertaken to assess liver function (using markers like SGPT, serum bilirubin, prothrombin time, serum albumin) in children suffering from Acute Lymphoblastic Leukemia.&#x0D; Materials &amp; Methods: This study was carried out in the Department of Pediatric Hematology &amp; Oncology, Dhaka Medical College Hospital, Dhaka, over a period 12 months from the day of approval of the protocol. All acute lymphoblastic leukaemia children admitted in Pediatric Hematology &amp; Oncology Department in Dhaka Medical College Hospital and receiving chemotherapy of standard protocol for induction of remission were the study population. A total of outcome variable was hepatotoxicity resulting from chemotherapy given for induction of remission.&#x0D; Result: The mean age of the children was 4.4 years (range 2- 8 years). Males were a bit higher in the series with male to female ratio being 11:9. Liver function tests before therapy revealed that none of the children exhibited raised serum billirubin and only 2(4.5%) children had increased SGPT. However, 50% of the children had raised prothrombin and 43.2% had reduced serum . albumin. Liver function tests after therapy after induction of remission shows that 9(20.5%) children exhibited raised serum billirubin, the proportion of children with raised prothrombin remained almost same as before but the status of serum billirubin improved to some extent. However, proportion of children with raised SGPT was increased to 25%. Comparison of liver function in children after therapy during induction of remission with that before induction did not show any significant difference, except that the serum SGPT was significantly raised during induction of remission (p &lt; 0.001).&#x0D; Conclusion: The study concluded that the current therapy for induction of remission of ALL cases does not produce any toxic effect on liver. Although, enzymes like SGPT take a sharp rise during induction of remission, it is transient and does produce any deleterious effect on liver.&#x0D; J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 33-37

Major Hepatectomy in a Child with Extremely Low Future Liver Remnant Without Posthepatectomy Liver Failure

Introduction: The threshold value of future liver remnant volume (FLR-V)-25% for healthy liver is a standard in adults liver surgery. This method was translated in pediatric population without correlation to age, weight and liver function in children. Assessment of future liver remnant function (FLR-F) by means of hepatobiliary scintigraphy (HBS) is supposed to be more precise tool in children undergoing extended liver resection. An experience of major hepatectomy (MH), accomplished despite the extremely low FLR-V in a 27mo boy with advanced hepatoblastoma (HB) is discussed below. Method: Since June 2017 in our Center investigation of both: FLR-V (CT-volumetry) and FLR-F by means of 99mTc-Mebrofenin HBS before liver resections became a standard practice. The cut-off value of FLR-F is 2.7%/min/m2. The decision about MH was made on the basis of received values. Results: According to preoperative CT-volumetry, in patient with HB involving segments 4,7,8,1 (POSTTEXT III) the FLR-V in S2,3 came to 16.5%. 99mTc-Mebrofenin HBS showed the FLR-F 3.95%/min/m2. Taking into consideration the sufficient FLR-F, the extended right hepatectomy and caudate lobectomy was implemented instead of two-staged hepatectomy (TSH). The postoperative course was uneventful with no signs of posthepatectomy liver failure (PHLF). Patient was discharged on POD 12 and started adjuvant chemotherapy on time. The repeat FLR-F investigation on POD 30 came to 15.8%/min/m2. Conclusion: The presented case depicts that FLR-F is more precise than FLR-V in prediction of PHLF. 99mTc-Mebrofenin HBS is a sensitive method in selection of pediatric patients for safe MH instead of TSH or liver transplantation.

Vitamin D and non-alcoholic fatty liver disease in children

Objective The aim of this study was to explore the serum 25-(OH)Vitamin D and its correlation with liver function in children who have suffered from non-alcoholic fatty liver disease(NAFLD), and to explore the necessity of vitamin D treatment of NAFLD in children. Methods Forty children with NAFLD diagnosed by imaging were selected from the outpatient of pediatric digestive department of Shengjing Hospital of China Medical University, selected as observation group from July 2017 to August 2019, and 37 healthy children were selected as control group.The clinical data were collected and serum 25-(OH)Vitamin D were detected at the same time. Results There was no significant difference in 25-(OH)Vitamin D among children with NAFLD at different ages and gender(P>0.05). The level of 25-(OH)Vitamin D in children with NAFLD[(21.30±8.77)μg/L]was significantly lower than that in the control group[(28.53±10.18)μg/L](t=3.343, P<0.01). The incidence of vitamin D deficiency(<20 μg/L)and insufficiency(<30 μg/L)in children with NAFLD(35/40=87.50%)was significantly higher than that in the control group(22/37=59.46%)(χ2=10.035, P<0.05). Serum 25-(OH)Vitamin D was negatively correlated with fasting insulin(r=-0.464, P<0.01)and homeostasis model assessment of insulin resistance(r=-0.444, P<0.01), but not correlated with BMI, transaminase level(ALT, AST), uric acid and blood lipid(TG, TC, HDL-C, LDL-C, sd-LDL, Apo-A1, Apo-B). Vitamin D deficiency was the risk factor of NAFLD(OR=1.088, P<0.01). Conclusion Vitamin D deficiency is common in pediatric NAFLD, which may be a risk factor of NAFLD.The mechanism may be that vitamin D deficiency aggravates insulin resistance and further aggravates liver damage in children with NAFLD. Key words: Children; Non-alcoholic fatty liver disease; 25-(OH)Vitamin D

A case of recurrent abnormal liver function in children resulting from neuroblastoma amplified sequence gene defect

现报道1例6岁男性患儿，临床反复出现肝脏损伤，肝损伤前均有发热，最终诊断为NBAS基因缺陷。与未发现NBAS突变的患者不同，确诊有NBAS突变的患者在每次肝功能损伤前均患有发热性疾病，发热24～72 h后可出现肝功能异常，甚至肝衰竭。以此提醒广大临床医师，反复出现发热相关性肝脏损伤患者应注意NBAS基因缺陷可能。.

Effects of Epstein–Barr virus infection on liver function in children

ObjectiveIn order to analyze the effect of Epstein–Barr (EB) virus infection on the liver function of children, the age and season of children susceptible to EB virus were analyzed in this study. MethodsIn this study, 118 children with EB infection from Cangzhou Central Hospital were selected as the subjects, and 10 children with normal liver function were selected as the control group. Compared with normal children, the changes of blood cells, immune cells and indicators related to liver function in patients with EB virus infection were compared, and the expression of EB virus -DNA in patients’ peripheral blood was analyzed. Immunohistochemistry was used to analyze the location and changes of CD4+T lymphocytes, CD8+T lymphocytes, and granzyme B cells in the liver of the patients. And changes in liver tissue were studied by in situ hybridization. ResultsIt was found that children in early childhood (1–3 years old) were the most susceptible group, and summer and autumn were the most susceptible seasons. Compared with normal children, the number of red blood cells and white blood cells in patients infected with EB virus increased, while the number of platelets decreased, but the difference was not significant. The liver function indexes of Alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), and lactate dehydrogenase (LDH) increased after infection. The content of CD4+T lymphocytes decreased, while that of CD8+T lymphocytes increased. The level of immune factor IgG increased significantly (P<0.01), granzyme B cells were positive compared to that of normal humans, and positive lymphocytes containing EBER appeared. ConclusionTherefore, EB virus may affect liver function by acting CD8+T lymphocytes in children.

A Retrospective Analysis of the Effect of Combination of Pure Fish Oil with Third Generation Lipid Emulsion on Liver Function in Children on Long-Term Parenteral Nutrition.

Background: Deterioration of liver function, or intestinal failure-associated liver disease, is often observed in long-term parenterally fed children. Fish oil-based intravenous lipids have been reported to play a role in the prevention and treatment of intestinal failure associated liver disease. Methods: This retrospective analysis included 40 pediatric patients, (20 male and 20 female), median age 38 months (range 1.5–200 months) on long-term (≥1 month) parenteral nutrition who received the parenteral mixtures containing a combination of a third-generation lipid emulsion and pure fish oil because of laboratory liver function abnormalities. The total dose of fish oil from both emulsions for each patient exceeded 0.5 g/kg/day. Data from visits in an outpatient clinic were retrospectively analyzed using the Wilcoxon test, Mann-Whitney test, and Spearman correlation test. Results: The median time of therapy was 149 days (range 28–418 days). There was a decrease of median total and direct (conjugated) bilirubin concentration from 22.23 µmol/L (range 3.42–243 µmol/L) to 10.26 µmol/L (range 3.42–180.58 µmol/L; p < 0.005) and 8.55 (range 1.71–212.04 µmol/L) to 6.84 µmol/L (range 1.71–150.48 µmol/L; p < 0.007) respectively. A significant decrease in median alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase was also observed. In 11 patients bilirubin concentrations increased or remained unchanged. When compared to the patients who responded to the combination therapy, the patients who did not respond received parenteral nutrition for a longer time prior to the start of the therapy (51 vs. 30 months; p < 0.05). Conclusions: The mixture of an intravenous lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil with the addition of pure fish oil emulsion may be helpful in the treatment of liver complications in children on long-term parenteral nutrition.

Postoperative abnormal liver function in children with heart surgery

To investigate the incidence of postoperative abnormal liver function test (aLFT) for the children with heart surgery, and to analyze the clinical characteristics and risk factors. Methods: A total of 143 children younger than 18 years old who underwent heart surgery in 2017 were enrolled in this study. The liver function were examined one day preoperation and consecutive 5 days after operation. The clinical data of perioperative period were recorded and the risk factors for aLFT were analyzed. Results: There were 43/143 (30%) cases had aLFT, including 5/143 (3.5%) acute liver injury (ALI). In the 6 liver function tests, total bilirubin, and glutamic-oxalacetic aminotransferase and glutamic-pyruvic aminotransferase increased to the peak at the first day and the second day after operation, respectively, and albumin declined to the lowest level at the fourth day after operation. aLFT happened most common at the first day after operation(22/43, 51.2%). The patients in the aLFT(+) group had smaller body size, more proportion of the risk adjustment for congenital heart sugery-1 (RACHS-1) score ≥ 3 and cyanosis, longer cardiopulmonary bypass (CPB) time, higher postoperative cardiac troponin (cTnI) value, higher inotropic score (IS), more transfusion, and longer mechanical ventilation time than those in the aLFT(-) group. The aLFT(+) group had longer ICU and hospital time, higher morbidity and mortality than those in the aLFT(-) group (P<0.05). Logistic regression showed that RACHS-1≥3, cyanosis, CPB time, cTnI, IS, transfusion, and mechanical ventilation time were the risk factors for aLFT. Multiple factor analysis showed the mechanical ventilation time was an independent risk factor for aLFT (P<0.05). Conclusion: aLFT is common in children after congenital heart operation, which could deteriorate to poor outcome. The mechanical ventilation time is an independent risk factor for aLFT.

Liver function in children with human immunodeficiency virus infection before and after 6 months of highly active antiretroviral therapy

Background Highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and improved survival rate in human immunodeficiency virus (HIV)-infected patients. Although the risk of morbidity has decreased, it has been replaced by other long-term complications, such as hepatotoxicity. Hepatotoxicity is often reflected in biochemical abnormalities of liver function, such as elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and aspartate aminotransferase-to-platelet ratio index (APRI).&#x0D; Objective To compare liver function spectrum (AST, ALT, and APRI) in HIV-infected children before and after at least 6 months of HAART.&#x0D; Methods This observational study (before and after) was conducted in pediatric patients with HIV infection who received HAART for at least 6 months at Sanglah Hospital, Denpasar. Data were collected from medical records.&#x0D; Results Forty-nine patients were observed in this study. The mean AST, ALT, and APRI levels before HAART were higher than after at least 6 months of HAART. Anti-tuberculosis treatment and fluconazole therapy were not confounding factors for AST, ALT, and APRI.&#x0D; Conclusion Liver function spectrum enzyme levels of AST, ALT, and APRI are improved after at least 6 months of HAART.

Indocyanine green clearance test to evaluate liver function in rat model of extrahepatic biliary atresia.

Background:Indocyanine green clearance test (ICG-K) has been shown as a sensitive marker of liver function in patients with cirrhosis. However, its role in the assessment of liver function in children with biliary atresia is not well established. The present study was undertaken to evaluate the ICG-K in an experimental model of cholangitis and partial biliary obstruction.Materials and Methods:Thirty albino rats were divided into 3 groups of 10 each. After exploration under anesthesia, a vial of OK-432 diluted in 0.2 ml of normal saline was injected into the common bile duct (CBD) in rats of Groups B and C. In the control Group A, only saline was injected. Re-exploration was done at 3 weeks in Groups A and B and at 6 weeks in Group C, and freshly prepared ICG was injected into the inferior vena cava. Blood samples were collected at periodic intervals, optical density of the serum was measured, and half-life of ICG and fractional clearance (K) were calculated. Blood and tissue samples were obtained for biochemical tests and histological examination.Results:The histological changes in CBD and liver were maximum in Group B; this correlated well with the K-value in this group, which was significantly delayed. In Group C, clearance was delayed than the control group with histological changes ranged from mild to moderate inflammation. The control group had normal histology of liver and CBD, and only four rats showed mild portal inflammation.Conclusion:ICG clearance rate is a reliable marker of liver function and can be utilized for evaluation of liver function in postoperative extrahepatic biliary atresia patients.