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Verma SK, Upadhyay P, Shukla S, Jain A, Shukla S, Patwa AK. Prognostic markers in hepatitis A-related pediatric acute liver failure and validation of the Peds-hepatitis A virus prognostic model. Indian J Gastroenterol 2024; 43:459-467. [PMID: 38568354 DOI: 10.1007/s12664-024-01551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/01/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES Hepatitis A virus (HAV) is the commonest cause for pediatric acute liver failure (PALF) in India. The objective of the study was to identify the predictors of mortality and to evaluate the utility of Peds-HAV model in a cohort of non-LT HAV-PALF. METHODS The study included HAV-related PALF from two non-transplant centers. The predictors of outcome were identified by univariate analysis followed by Cox regression analysis. The prognostic accuracy of Peds-HAV model, King's College Hospital (KCH) criteria and pediatric end-stage liver disease score (PELD) were evaluated. RESULTS As many as 140 children with PALF were included, of whom 96 (68.6%) children had HAV-PALF. On Cox regression analysis, international normalized ratio (INR) (p < 0.001), jaundice to encephalopathy (JE) interval (p < 0.001) and hepatic encephalopathy (HE) grade 3/4 (p = 0.01) were independent predictors of mortality. The mortality rates were 0% (0/42), 14.3% (3/21), 60% (9/15) and 94.4% (17/18) when none, 1, 2 or 3 criteria of the Peds-HAV were met, respectively. Peds-HAV model at a listing cut-off of ≥ 2 criteria predicted death with 89.7% sensitivity and 89.6% specificity. In contrast, KCH criteria had a lower sensitivity of 62.1%. PELD score had a sensitivity of 89.7% and specificity of 85.1% at a cut-off of 30. The overall prognostic accuracy of Peds-HAV model (89.6%) was higher than those of KCH (83.3%) and PELD (86.5%). CONCLUSION INR, HE grade and JE interval were independent predictors of mortality. The study provides an external validation of Peds-HAV model as a prognostic score in HAV-PALF. CLINICAL TRIAL REGISTRY NUMBER Not applicable as this is a retrospective study.
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Affiliation(s)
- Sanjeev Kumar Verma
- Department of Pediatrics, King George Medical University, Lucknow, 226 003, India.
| | - Piyush Upadhyay
- Department of Pediatrics, Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, 226 010, India
| | - Stuti Shukla
- Department of Pediatrics, King George Medical University, Lucknow, 226 003, India
| | - Amita Jain
- Department of Microbiology, King George Medical University, Lucknow, 226 003, India
| | - Suruchi Shukla
- Department of Microbiology, King George Medical University, Lucknow, 226 003, India
| | - Ajay Kumar Patwa
- Department of Medicine, King George Medical University, Lucknow, 226 003, India
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Vento S, Cainelli F. Acute liver failure in low-income and middle-income countries. Lancet Gastroenterol Hepatol 2023; 8:1035-1045. [PMID: 37837969 DOI: 10.1016/s2468-1253(23)00142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 10/16/2023]
Abstract
Acute liver failure is a rare condition involving the rapid development, progression, and worsening of liver dysfunction, characterised by coagulopathy and encephalopathy, and has a high mortality unless liver transplantation is performed. Population-based studies are scarce, and most published data are from high-income countries, where the main cause of acute liver failure is paracetamol overdose. This Review provides an overview of the scanty literature on acute liver failure in low-income and middle-income countries, where patients are often admitted to primary care hospitals and viral hepatitis (especially hepatitis E), tropical infections (eg, dengue), traditional medicines, and drugs (especially anti-tuberculosis drugs) have an important role. We discuss incidence, cause, occurrence in children and pregnant women, prognostic factors and scores, treatment, and mortality. To conclude, we advocate for international collaboration, the establishment of central registries for the condition, and better diagnostics.
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Affiliation(s)
- Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia.
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Lenz D, Hørby Jørgensen M, Kelly D, Cardinale V, Geerts A, Gonçalves Costa I, Fichtner A, Garbade SF, Hegen B, Hilberath J, de Kleine R, Kupčinskas L, McLin V, Niesert M, Prado Gonzalez V, Sturm E, Staufner C, Tjwa E, Willemse J, Zecher BF, Larsen FS, Sebode M, Ytting H. Etiology and Outcome of Adult and Pediatric Acute Liver Failure in Europe. J Pediatr Gastroenterol Nutr 2023; 77:115-120. [PMID: 36930963 DOI: 10.1097/mpg.0000000000003777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Acute liver failure (ALF) is rare but life-threatening. Common causes include intoxications, infections, and metabolic disorders. Indeterminate etiology is still frequent. No systematic data on incidence, causes, and outcome of ALF across Europe are available. Via an online survey we reached out to European Reference Network Centers on rare liver diseases. Numbers and etiology of ALF cases during 2020 were retrieved and diagnostic and treatment availabilities assessed. In total, 455 cases (306 adult, 149 pediatric) were reported from 36 centers from 20 countries. Intoxication was the most common cause in adult and pediatric care. The number of cases with indeterminate etiology is low. Diagnostic tools and specific treatment options are broadly available within this network. This is the first approach to report on etiology and outcome of ALF in the pediatric and adult population in Europe. High diagnostic yield and standard of care reflects the expert status of involved centers.
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Affiliation(s)
- Dominic Lenz
- From the Department of Pediatrics I, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Marianne Hørby Jørgensen
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Department of Pediatrics and Adolescent Medicine, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Deirdre Kelly
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Liver Unit, Birmingham Women's and Children's Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Vincenzo Cardinale
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Medical-Surgical and Biotechnologies Sciences, Polo Pontino, Sapienza University of Rome, Latina, Italy
| | - Anja Geerts
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Hepatology Research Unit, Department of Internal Medicine and Paediatrics, Liver Research Center Ghent, Ghent University, Ghent, Belgium
| | - Isabel Gonçalves Costa
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Unidade de Hepatologia e Transplantação Hepática Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Alexander Fichtner
- From the Department of Pediatrics I, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Sven F Garbade
- From the Department of Pediatrics I, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Bianca Hegen
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hilberath
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Paediatric Gastroenterology/Hepatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ruben de Kleine
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Limas Kupčinskas
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Institute for Digestive Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Valérie McLin
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Swiss Pediatric Liver Center, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland
| | - Moritz Niesert
- From the Department of Pediatrics I, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Veronica Prado Gonzalez
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Ekkehard Sturm
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Paediatric Gastroenterology/Hepatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Christian Staufner
- From the Department of Pediatrics I, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Eric Tjwa
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Willemse
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Dutch Liver Patient Association (NLV), Hoogland, The Netherlands
| | - Britta F Zecher
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Fin Stolze Larsen
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Department of Gastroenterology and Hepatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marcial Sebode
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Henriette Ytting
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- the Gastro Unit, Medical Division, Hvidovre University Hospital, Copenhagen, Denmark
- the Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Zhou YJ, Gu HY, Tang QQ, Li F, Zhu J, Ai T, Zhu K, Xu BY, Wang Q, Huang AL, Chen J, Zhang ZZ. Case report: A case of severe acute hepatitis of unknown origin. Front Pediatr 2022; 10:975628. [PMID: 36275068 PMCID: PMC9579323 DOI: 10.3389/fped.2022.975628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
According to analyses of etiology, clinical features, diagnostic methods, and treatment strategies by summarizing a case of unexplained acute hepatitis recently experienced, we are aiming to provide some information to enrich the clinical experience in diagnosis and treatment of severe acute hepatitis of unknown etiology in young children. A boy, aged 10 years and 6 months old, was admitted to the hospital due to acute abdominal pain, jaundice, and exceptionally high levels of ALT and AST. A range of measures, including patient history, physical examination, and routine laboratory testing, were performed. Furthermore, strategies such as trio-based next-generation sequencing (Trio-NGS) and liver biopsy, as well as metagenomic NGS (mNGS) of blood and liver samples were also performed. In summary, this case was an acute severe non-A-E hepatitis that is a probable case with hepatitis of unknown origin. Immunohistochemical analysis showed an immune injury in liver tissues. Torque teno virus (TTV) sequences were detected by mNGS assay. As for treatment strategies, in addition to general treatment, this patient also underwent plasmapheresis and methylprednisolone treatment due to disease deterioration. The patient's liver function was improved afterward and discharged after one month of treatment. Taken together, this work reported the clinical feature and treatment of severe acute hepatitis with non-A-E hepatitis in detail. The potential mechanism of liver damage might be due to an immune attack in which TTV might play a role as a co-factor.
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Affiliation(s)
- Yu-Jiao Zhou
- The Key Laboratory of Molecular Biology of Infectious Diseases Designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Hui-Ying Gu
- The Key Laboratory of Molecular Biology of Infectious Diseases Designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Qi-Qin Tang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Department of Infectious Disease, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fan Li
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Zhu
- Department of Pathology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Ai
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Department of Infectious Disease, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Zhu
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Bin-Yue Xu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Qing Wang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Ai-Long Huang
- The Key Laboratory of Molecular Biology of Infectious Diseases Designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Juan Chen
- The Key Laboratory of Molecular Biology of Infectious Diseases Designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China.,Key Laboratory of Laboratory Medical Diagnostics, Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Zhen-Zhen Zhang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Department of Infectious Disease, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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