Hussain Elora, Grimason Michele, Goldstein Joshua, Smith Craig M, Alonso Estella, Whitington Peter F, Wainwright Mark S
*Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program †Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL.
J Pediatr Gastroenterol Nutr. 2014 Apr;58(4):449-56. doi: 10.1097/MPG.0000000000000271.
There are limited data on the incidence of seizures and utility of brain imaging and electroencephalogram (EEG) to predict outcome of children with acute liver failure (ALF). We investigated the association between hepatic encephalopathy (HE) scores, abnormal EEG or neuroimaging, and short-term outcome.
Single-center retrospective observational study of infants and children with ALF who underwent continuous EEG monitoring and brain imaging within 24 hours of admission to the intensive care unit (ICU).
A total of 19 patients with ALF with a mean age of 6.8 ± 1.5 years were evaluated. The majority of cases (74%) were indeterminate. Of the total, 10 patients (53%) survived to discharge without liver transplant (LT), 5 (26%) received LT, and 4 (21%) died without LT. Seizures occurred in only 2 cases (19%). Patients who had an abnormal EEG on admission (n = 7) were significantly more likely to die or require LT (P < 0.05, Fisher exact test). Patients with either an admission HE score ≤ 2, or liver injury unit score <222, combined with a normal or mildly abnormal EEG were more likely to survive without LT. Neuroimaging was normal in the majority of cases (87%) and was not associated with outcome.
Children with a moderate or severe abnormality of EEG background on admission were significantly more likely to require LT or to die. Children with an HE score ≤ 2, and a normal or only mildly abnormal EEG, were significantly more likely to survive without needing LT. These findings are an initial step toward distinguishing patients with ALF who may recover spontaneously from those who will require LT.
关于急性肝衰竭（ALF）患儿癫痫发作的发生率以及脑成像和脑电图（EEG）预测预后的效用的数据有限。我们研究了肝性脑病（HE）评分、异常EEG或神经影像学与短期预后之间的关联。
对入住重症监护病房（ICU）24小时内接受持续EEG监测和脑成像的ALF婴幼儿及儿童进行单中心回顾性观察研究。
共评估了19例平均年龄为6.8±1.5岁的ALF患者。大多数病例（74%）情况不明。其中，10例患者（53%）存活至出院且未接受肝移植（LT），5例（26%）接受了LT，4例（21%）未接受LT而死亡。仅2例（19%）发生了癫痫发作。入院时EEG异常的患者（n = 7）死亡或需要LT的可能性显著更高（P < 0.05，Fisher精确检验）。入院时HE评分≤2或肝损伤单位评分<222且EEG正常或轻度异常的患者更有可能在未接受LT的情况下存活。大多数病例（87%）的神经影像学正常，且与预后无关。
入院时EEG背景有中度或重度异常的儿童需要LT或死亡的可能性显著更高。HE评分≤2且EEG正常或仅轻度异常的儿童在不需要LT的情况下存活的可能性显著更高。这些发现是区分可能自发恢复的ALF患者和需要LT的患者的初步步骤。
