Zhao Pan, Wang Chun-Ya, Liu Wei-Wei, Wang Xi, Yu Li-Ming, Sun Yan-Rong
Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), Beijing 100039, China.
Hepatobiliary Pancreat Dis Int. 2014 Jun;13(3):276-80. doi: 10.1016/s1499-3872(14)60041-2.
Currently, no documentation is available regarding Chinese children with acute liver failure (ALF). This study was undertaken to investigate etiologies and outcomes of Chinese children with ALF.
We retrospectively enrolled 32 pediatric patients with ALF admitted in five hospitals in different areas of China from January 2007 to December 2012. The coagulation indices, serum creatinine, serum lactate dehydrogenase, blood ammonia and prothrombin activity were analyzed; the relationship between these indices and mortality was evaluated by multivariate analysis.
The most common causes of Chinese children with ALF were indeterminate etiology (15/32), drug toxicity (8/32), and acute cytomegalovirus hepatitis (6/32). Only 1 patient (3.13%) received liver transplantation and the spontaneous mortality of Chinese children with ALF was 58.06% (18/31). Patients who eventually died had higher baseline levels of international normalized ratio (P=0.01), serum creatinine (P=0.04), serum lactate dehydrogenase (P=0.01), blood ammonia (P<0.01) and lower prothrombin activity (P=0.01) than those who survived. Multivariate analysis showed that the entry blood ammonia was the only independent factor significantly associated with mortality (odds ratio=1.069, 95% confidence interval 1.023-1.117, P<0.01) and it had a sensitivity of 94.74%, a specificity of 84.62% and an accuracy of 90.63% for predicting the death. Based on the established model, with an increase of blood ammonia level, the risk of mortality would increase by 6.9%.
The indeterminate causes predominated in the etiologies of ALF in Chinese children. The spontaneous mortality of pediatric patients with ALF was high, whereas the proportion of patients undergoing liver transplantation was significantly low. Entry blood ammonia was a reliable predictor for the death of pediatric patients with ALF.
目前，尚无关于中国儿童急性肝衰竭（ALF）的文献报道。本研究旨在调查中国儿童ALF的病因及预后情况。
我们回顾性纳入了2007年1月至2012年12月在中国不同地区五家医院收治的32例儿科ALF患者。分析了凝血指标、血清肌酐、血清乳酸脱氢酶、血氨及凝血酶原活动度；通过多因素分析评估这些指标与死亡率之间的关系。
中国儿童ALF最常见的病因是病因不明（15/32）、药物毒性（8/32）和急性巨细胞病毒肝炎（6/32）。仅1例患者（3.13%）接受了肝移植，中国儿童ALF的自发死亡率为58.06%（18/31）。最终死亡的患者国际标准化比值（P=0.01）、血清肌酐（P=0.04）、血清乳酸脱氢酶（P=0.01）、血氨（P<0.01）的基线水平较高，而凝血酶原活动度（P=0.01）较低。多因素分析显示，入院时血氨是与死亡率显著相关的唯一独立因素（比值比=1.069，95%置信区间1.023-1.117，P<0.01），其预测死亡的敏感度为94.74%，特异度为84.62%，准确度为90.63%。基于建立的模型，随着血氨水平升高，死亡风险将增加6.9%。
中国儿童ALF病因中病因不明者占主导。儿科ALF患者自发死亡率高，而接受肝移植的患者比例显著较低。入院时血氨是儿科ALF患者死亡的可靠预测指标。
