CLINICO EPIDIMIOLOGICAL AND ETIOLOGICAL PROFILE OF ACUTE LIVER FAILURE IN CHILDREN

Abstract

Background: Pediatric Acute Liver Failure (PALF) represents one of the most challenging of all pediatric critical illnesses. It combines the management of rapidly progressive, severe multisystem organ failure, unpredictable and potential devastating complications.

Aim: To find out the clinical, epidemiological and Etiological profile of Pediatric Acute Liver Failure.

Methods: A profile of 65 consecutive children in this Hospital-based cross sectional observational study diagnosed with Pediatric acute liver failure at Postgraduate Department of Pediatrics, Children hospital Srinagar over a period of 18 months were taken up for the study. The children were followed up to their discharge, death or referral to higher center.  A predesigned pro forma was used to record the socio-demographic details, detailed  history , examination and investigations of the enrolled patients. Children with the past history of liver disease or physical signs of chronic liver disease were excluded from the study.

Results: Mean age of the study subjects was 7.0± 3.3 years. Majority of the patients in our study were from district Anantnag (21.5%) followed by Budgam (18.5%). The most common clinical presentation was anorexia which was present in 50 of the patients that is 76.9%, followed next in frequency by Vomiting (75.4%), jaundice in 47patients (72.3%), fever (60%), abdominal pain (40%) and features of Hepatic Encephalopathy that is Irritability (10.8%), Sleep cycle change (33.8%) and behaviour changes in 23.1%. Hepatic encephalopathy present at admission was observed to be significant predictor of mortality. Higher grade of encephalopathy present at admission was a significant predictor of mortality. Serum bilirubin was high in 98.5% of the patients whose trend correlated with the clinical profile and outcome of patients. Hepatitis A was diagnosed as cause of ALF in 72.3% patients followed by Indeterminate in 7.7% of patients, GALD in 4.6%, Wilsons and Autoimmune as cause in 4.6 % respectively.

Conclusion: In conclusion, PALF is a life-threatening condition. For this reason, referring the patient to a liver transplant center on time, estimating the likelihood of spontaneous survival, and identifying patients who cannot recover without LT is necessary.