medigraphic.com
ISSN 1527-3172 (Electronic)

2015, Number 1

<< Back Next >>

MEDICC Review 2015; 17 (1)

Acute liver failure in cuban children

Silverio GCE, Smithen-Romany CY, Hondal ÁNI, Díaz THO, Castellanos FMI, Sosa PO

Language: English
References: 55
Page: 48-54
PDF size: 106.26 Kb.


ABSTRACT

INTRODUCTION Acute liver failure is rare in pediatric patients and is one of the most challenging medical emergencies due to its prognostic and therapeutic implications. The best scientific evidence worldwide comes from multicenter studies in developed countries. In Cuba, there are no prior studies of this disorder in children.
OBJECTIVES Describe the main clinical features of Cuban children treated at a national referral center for acute liver failure, as defined by recognized diagnostic criteria for pediatric patients.
METHODS A case series study was conducted comprising patients diagnosed with acute liver failure treated from 2005 to 2011 in the hepatology and liver transplant service at Havana's William Soler University Children's Hospital. Variables were age group, etiology of acute liver failure, grade of hepatic encephalopathy, blood chemistry variables, and clinical outcome (whether or not spontaneous recovery of liver function occurred). Associations between variables were assessed using contingency tables, and case fatality was calculated, as well as relative risk with its 95% confidence interval. The Mann-Whitney U test was used to compare means of laboratory test results.
RESULTS Median age of the 31 patients studied (14 boys and 17 girls) was 24 months (range 1–180). Time between symptom onset and diagnosis of acute liver failure was 25.1 days (SD 16.8). Infection was the most common etiology, present in 61.3% of cases (19/31); nonhepatotropic viruses, especially cytomegalovirus, predominated in infants. Spontaneous recovery occurred in 15 patients (48.4%), 3 (9.7%) received transplants, and 13 died, for a case fatality of 41.9%. Outcome was not associated with etiology (p = 0.106), but was statistically associated with degree of hepatic encephalopathy (p ‹ 0.01): 77.8% of patients (7/9) with grades III–IV encephalopathy died, for a relative risk of 4.0 (95% CI 1.15–13.8), versus 11.1% (1/9) with grade II or less encephalopathy. Cholesterol levels were significantly lower in patients who failed to recover spontaneously (p ‹ 0.01).
CONCLUSIONS Patients' clinical characteristics in this case series were similar to those described in developed countries.The fact that nonhepatotropic viruses (basically, cytomegalovirus in infants) are the main cause of acute liver failure in Cuban children calls for further epidemiologic study and identification of local underlying determinants of this phenomenon.


REFERENCES

  1. Craig DG, Lee A, Hayes PC, Simpson KJ. Review article: the current management of acute liver failure. Alimentary Pharmacol Ther. 2010 Feb 1;31(3):345–58.

  2. Devictor D, Tissieres P, Afanetti M, Debray D. Acute liver failure in children. Clin Res Hepatol Gastroenterol. 2011 Jun;35(6–7):430–7.

  3. Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis. 1970;3:282–98.

  4. Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RA. Systematic review: acute liver failure—one disease, more than 40 defi nitions. Aliment Pharmacol Ther. 2012 Jun;35(11):1245–56.

  5. Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011. Hepatology. 2012 Mar;55(3):965–7.

  6. Bhaduri BR, Mieli-Vergani G. Fulminant hepatic failure: pediatric aspects. Semin Liver Dis. 1996 Nov;16(4):349–55.

  7. Squires R. Acute liver failure in children. Semin Liver Dis. 2008;28:153–66.

  8. Alonso E, Squires R, Whitington P. Acute Liver Failure in Children. In: Suchy FJ, Sokol RJ, Balistreri WF, editors. Liver Disease in Children. 3rd ed. Cambridge: Cambridge University Press; 2007. p.71–96.

  9. Dhawan A. Etiology and prognosis of acute liver failure in children. Liver Transpl. 2008 Oct;14 Suppl 2:S80–4.

  10. Poddar B, Saigal S, Kumar A, Singh RK, Azim A, Gurjar M, et al. Factors associated with outcome in acute liver failure in an intensive care unit. Indian J Gastroenterol. 2013 May;32(3):172–8.

  11. Lee WS, McKiernan P, Kelly DA. Etiology, outcome and prognostic indicators of childhood fulminant hepatic failure in the United Kingdom. J Pediatr Gastroenterol Nutr. 2005 May;40(5):575–81.

  12. Lu BR, Gralla J, Liu E, Dobyns EL, Narkewicz MR, Sokol RJ. Evaluation of a scoring system for assessing prognosis in pediatric acute liver failure. Clin Gastroenterol Hepatol. 2008 Oct;6(10):1140–5.

  13. Sundaram V, Shneider BL, Dhawan A, Ng VL, Im K, Belle S, et al. King’s College Hospital Criteria for non-acetaminophen induced acute liver failure in an international cohort of children. J Pediatr. 2013 Feb;162(2):319–23.

  14. Hospital Pediátrico William Soler [Internet]. Havana: Ministry of Public Health (CU); c1999– 2014 [cited 2014 Feb 13]. Available from: http:// www.sld.cu/sitios/williamsoler/. Spanish.

  15. Baker A, Alonso ME, Aw MM, Ciocca M, Porta G, Rosenthal P. Hepatic failure and liver transplant: Working Group report of the second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Ped Gastroenterol Nut. 2004 Jun;39 Suppl 2:S632–9.

  16. Squires R. Acute liver failure and the pediatric patient. In: Remaley L, McGhee B, Reyes J, Mazariegos G, editors. The Pediatric Transplant Manual. 2nd ed. Pittsburgh: Lexi Comp; 2009. p. 9–29.

  17. Alvarez F, Berg PA, Bianchi FB, Bianchi L, BurroughsAK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999 Nov;31(5):929–38.

  18. Whitington PF, Alonso EM. Fulminant hepatitis in children: evidence for an unidentifi ed hepatitis virus. J Pediatr Gastroenterol Nutr. 2001 Nov;33(5):529–36.

  19. Delic D, Mitrovic N, Spurnic AR, SvirtlihNS, Babic JS. Epidemiological characteristics and clinical manifestations of acute non-A–E hepatitis. Vojnosanit Pregl. 2010 Nov;67(11):903–9.

  20. Polson J, Lee WM. American Association for the Study of Liver Diseases Position Paper: The management of acute liver failure. Hepatology. 2005 May;41(5):1179–97.

  21. Rustom N, Bost M, Cour-Andlauer F, Lachaux A, Brunet AS, Boillot O, et al. Effect of molecular adsorbents recirculating system treatment in children with acute liver failure caused by Wilson disease. J Pediatr Gastroenterol Nutr. 2014 Feb;58(2):160–4.

  22. Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics; Bhatia V, Bavdekar A, Yachha SK; Indian Academy of Pediatrics. Management of acute liver failure in infants and children: consensus statement of the pediatric gastroenterology chapter, Indian academy of pediatrics. Indian Pediatr. 2013 May 8;50(5):477–82.

  23. Squires RH Jr, Shneider BL, Bucuvalas J, Alonso E, Sokol RJ, Narkewicz MR, et al. Acute liver failure in children: the fi rst 348 patients in the pediatric acute liver failure study group. J Pediatr. 2006 May;148(5):652–8.

  24. Sundaram SS, Alonso EM, Narkewicz MR, Zhang S, Squires RH; Pediatric Acute Liver Failure Study Group. Characterization and outcomes of young infants with acute liver failure. J Pediatr. 2011 Nov;159(5):813–8.

  25. Yu YD, Park GC, Park PJ, Choi YI, Hwang S, Song GW, et al. Cytomegalovirus infection-associated fulminant hepatitis in an immunocompetent adult requiring emergency living-donor liver transplantation: report of a case. Surg Today. 2013 Apr;43(4):424–8.

  26. Acosta C, Pérez X, García R. Presencia de anticuerpos IgG al virus de la rubeola, virus herpes simple y citomegalovirus en niños cubanos. Bioquimia. 2000 Jan–Mar;25(1):10–2. Spanish.

  27. Correa C, Kourí V, Pérez L, Alemán Y, Soto Y, Álvarez A, et al. Infecciones por virus de Epstein- Barr y citomegalovirus en pacientes con síndrome mononucleósico. Panorama Cuba y Salud. 2013 Sep–Dec;8(3):15–20. Spanish.

  28. Black DD. The continuing challenge of “indeterminate” acute liver failure in children. J Pediatr. 2009 Dec;155(6):769–70.

  29. Bravo LC, Gregorio GV, Shafi F, Bock HL, Boudville I, Liu Y, et al. Etiology, incidence and outcomes of acute hepatic failure in 0–18 year old Filipino children. Southeast Asian J Trop Med Public Health. 2012 May;43(3):764–72.

  30. Kaur S, Kumar P, Kumar V, Sarin SK, Kumar A. Etiology and prognostic factors of acute liver failure in children. Indian Pediatr. 2013 Jul;50(7):677–9.

  31. Ciocca M, Moreira-Silva SF, Alegría S, Galoppo MC, Ruttiman R, Porta G, et al. Hepatitis A as an etiologic agent of acute liver failure in Latin America. Pediatr Infect Dis J. 2007 Aug;26(8):711–5.

  32. Ciocca M, Ramonet M, Cuarterolo M, López S, Cernadas C, Álvarez F. Prognostic factors in paediatric acute liver failure. Arch Dis Child. 2008 Jan;93(1):48–51.

  33. Uribe M, Buckel E, Ferrario M, Godoy J, Blanco A, Hunter B, et al. Epidemiology and results of liver transplantation for acute liver failure in Chile. Transpl Proc. 2003 Nov;35(7):2511–2.

  34. Ferreira CT, Vieira SM, Kieling CO, Silveira TR. Hepatitis A acute liver failure: follow-up of paediatric patients in southern Brazil. J Viral Hepat. 2008 Oct;15Suppl 2:66–8.

  35. Moreira-Silva SF, Frauches DO, Almeida AL, Mendonça HF, Pereira FE. Acute liver failure in children: observations in Vitoria, Espirito Santo State, Brazil. Rev Soc Bras Med Trop. 2002 Sep–Oct;35(5):483–6.

  36. National Health Statistics and Medical Records Division (CU). Estadísticas de Salud [Internet]. Havana: Ministry of Public Health (CU); c2014. Series de Tiempo de Morbilidad. Cuba 1970- 2010; 2011 Dec [cited 2013 May 20]. Available from: http://fi les.sld.cu/dne/fi les/2011/12/serie -de-morbilidad-1970-2010.pdf. Spanish.

  37. Castañeda C. Hepatitis B crónica en la infancia. In: Hernández JCSM, editor. Hepatología 2006. Havana: Ediciones CIMEQ; 2006. p. 231–43. Spanish.

  38. Brett A, Carvalho L, Garcia P, Diogo L, Gonçalves I. Acute liver failure in under two year-olds –are there markers of metabolic disease on admission? Ann Hepatol. 2013 Sep– Oct;12(5):791–6.

  39. Cakir B, Kirbas I, Demirhan B, Tarhan NC, Bozkurt A, Ozcay F, et al. Fulminant hepatic failure in children: etiology, histopathology and MDCT fi ndings. Eur J Radiol. 2009 Nov;72(2):327–34.

  40. Devarbhavi H, Singh R, Adarsh CK, Sheth K, Kiran R, Patil M. Factors that predict mortality in children with Wilson disease associated acute liver failure and comparison of Wilson disease specifi c prognostic indices. J Gastroenterol Hepatol. 2014 Feb;29(2):380–6.

  41. Fragoso T, Garcia E, Escobar MP, Castañeda C, Pomar F, Gra B, et al. Clinical presentation and diagnosis of Wilson disease in Cuban children and adolescents. J Pediatr Gastroenterol Nutr. 2004;39:S138–9.

  42. Dhawan A, Taylor RM, Cheeseman P, De Silva P, Katsiyiannakis L, Mieli-Vergani G. Wilson’s Disease in Children: 37-Year Experience and Revised King’s Score for Liver Transpl. Liver Transpl. 2005 Apr;11(4):441–8.

  43. Mieli-Vergani G, Vergani D. Paediatric autoimmune liver disease. Arch Dis Childhood. 2013 Dec;98(12):1012–7.

  44. Latif N, Mehmood K. Risk factors for fulminant hepatic failure and their relation with outcome in children. J Pak Med Assoc. 2010 Mar;60(3):175–8.

  45. Rajanayagam J, Coman D, Cartwright D, Lewindon PJ. Pediatric acute liver failure: etiology, outcomes, and the role of serial pediatric end-stage liver disease scores. Pediatr Transplant. 2013 Jun;17(4):362–8.

  46. Lu BR, Zhang S, Narkewicz MR, Belle SH, Squires RH, Sokol RJ, et al. Evaluation of the liver injury unit scoring system to predict survival in a multinational study of pediatric acute liver failure. J Pediatr. 2013 May;162(5):1010–6.

  47. Durand P, Debray D, Mandel R, Baujard C, Branchereau S, Gauthier F, et al. Acute liver failure in infancy: a 14-year experience of a pediatric liver transplantation center. J Pediatr. 2001 Dec;139(6):871–6.

  48. Liu E, MacKenzie T, Dobyns EL, Parikh CR, Karrer FM, Narkewicz MR, et al. Characterization of acute liver failure and development of a continuous risk of death staging system in children. J Hepatol. 2006 Jan;44(1):134–41.

  49. Bouguila J, Mabrouk S, Tilouche S, Bakir D, Trabelsi A, Hmila A, et al. Giant cell hepatitis with autoimmune hemolytic anemia in a nine month old infant. World J Hepatol. 2013 Apr 27;5(4):226–9.

  50. Bucuvalas J, Yazigi N, Squires RH Jr. Acute liver failure in children. Clin Liver Dis. 2006 Feb;10(1):149–68.

  51. Sherlock S, Dooley J. Assessment of Liver Function. In: Sherlock S, Dooley J, editors. Diseases of the Liver and Biliary System. 11th ed. Oxford: Blackwell Publishing; 2002 Jan. p. 19–35.

  52. Rivera-Penera T, Moreno J, Skaff C, McDiarmid S, Vargas J, Ament ME. Delayed encephalopathy in fulminant hepatic failure in the pediatric population and the role of liver transplantation. J Ped Gastroenterol Nutr. 1997 Feb;24(2):128–34.

  53. Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RA. A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality. Liver Int. 2013 Jan;33(1):40–52.

  54. Huo TI, Wu JC, Sheng WY, Chan CY, Hwang SJ, Chen TZ, et al. Prognostic factor analysis of fulminant and subfulminant hepatic failure in an area endemic for hepatitis B. J Gastroenterol Hepatol. 1996 Jun;11(6):560–5.

  55. Miloh T, Suchy F. Fulminant Hepatic Failure. In: Elzouki AY, editor. Textbook of Clinical Pediatrics. Springer-Verlag (DE): Ed. Berlin; 2012. p. 2095–100.




2020     |     www.medigraphic.com