Lal Bikrant B, Sood Vikrant, Gupta Ekta, Agarwal Reshu, Khanna Rajeev, Alam Seema
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
J Clin Exp Hepatol. 2023 May 26;13(5):912-6. doi: 10.1016/j.jceh.2023.05.014.
Adenovirus, adeno-associated virus, and severe acute respiratory syndrome-coronavirus-2 (SARS-COV2) have been recently implicated as probable causative agents of severe acute hepatitis of unknown etiology reported from most of Europe. High mortality and liver transplantation (LT) rates have been observed in those presenting with acute liver failure (ALF). Such cases have not been reported from the Indian subcontinent. We analyzed the etiologies, clinical course, and in-hospital outcomes of cases of severe acute hepatitis with ALF presenting to us between May and October 2022. A total of 178 children presented with severe acute hepatitis of known/unknown etiology including 28 presenting as ALF. Eight of them fulfilled the definition of severe acute hepatitis of unknown etiology presenting as ALF. Adenovirus was not associated with cases of ALF in these children. SARS-COV2 antibodies were detected in 6 (75%) of them. Children with severe acute hepatitis of unknown etiology presenting as ALF were young (median age 4 years), had hyper-acute presentation with a predominance of gastrointestinal symptoms, and a fulminant course with worse outcomes (native liver survival 25%). Expedited evaluation of these children for LT would be the key to management.
腺病毒、腺相关病毒和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）最近被认为是欧洲大部分地区报告的病因不明的严重急性肝炎的可能致病因素。在出现急性肝衰竭（ALF）的患者中观察到高死亡率和肝移植（LT）率。印度次大陆尚未报告此类病例。我们分析了2022年5月至10月期间向我们就诊的伴有ALF的严重急性肝炎病例的病因、临床病程和院内结局。共有178名儿童出现病因已知/未知的严重急性肝炎，其中28名表现为ALF。其中8名符合表现为ALF的病因不明的严重急性肝炎的定义。腺病毒与这些儿童的ALF病例无关。6名（75%）儿童检测到SARS-CoV-2抗体。表现为ALF的病因不明的严重急性肝炎儿童年龄较小（中位年龄4岁），呈超急性表现，以胃肠道症状为主，病程凶险，预后较差（原位肝存活率25%）。对这些儿童进行LT的快速评估将是管理的关键。
