Aetiology, clinical profile and prognostic indicators for children with acute liver failure admitted in a teaching hospital in Kolkata

Abstract

Objective: To estimate the prevalence of hepatotropic viruses in the causation of acute liver failure in children admitted to a tertiary hospital in Kolkata.

Design: Analysis of clinical and laboratory parameters (including viral markers) of children with acute liver failure using a predesigned, structured proforma.

Subjects and settings: Admitted patients aged from 1 through 12 years who met the criteria of acute liver failure were included in the study.

Results: Of the 45 patients in our study, a majority was from the southern part of West Bengal. Their mean age was 7.12 +/- 0.37 years. The male: female ratio was 1:1.25. It was possible to determine the aetiology in 35 of the 45 patients (77.7%) admitted. Of these 35, a diagnosis of hepatitis due to hepatotropic viruses was made in 30 patients. The hepatitis A virus was responsible for 16 of the 30 cases (53.3%), 9 cases attributed to HAV only. Following this was the hepatitis E virus causing ALF in 14 cases (46.6%), 7 singularly so. Hepatitis B virus caused 8 cases (26.6%), 6 singly. The survival rate during hospital stay was 51.1%. Prodrome, decreased liver span, ascites, cerebral oedema, coagulopathy, renal failure, spontaneous bacterial peritonitis, signs and symptoms of clinical sepsis (corroborated by laboratory data), severe hypoalbuminaemia and electrolyte imbalance were significantly more in patients who died. The mean age, prothrombin time, serum bilirubin level and stage of encephalopathy differed significantly between survivors and non-survivors.

Conclusion: In southern Bengal, hepatotropic viruses are the predominant cause of acute liver failure in children. Of these, the hepatitis viruses A and E transmitted via the enteric route dominate (24 of 30 cases).