Ravindranath Aathira, Srivastava Anshu, Yachha Surender K, Poddar Ujjal, Sarma Moinak S, Mathias Amrita
Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Clin Exp Hepatol. 2024 Nov-Dec;14(6):101452. doi: 10.1016/j.jceh.2024.101452. Epub 2024 May 31.
Hepatic encephalopathy (HE) is a marker of poor prognosis in adults with chronic liver disease (CLD). We prospectively studied the prevalence and precipitants of HE in children with CLD as there is a paucity of literature on the same.
Children (1-18 years) admitted with CLD were examined daily for the presence and grading of HE (West Haven/Whittington grading). Precipitants were classified as infection, dyselectrolytemia, gastrointestinal bleeding, constipation and dehydration. Changes in grades of HE and outcome were noted.
One hundred and sixty children (age 120 [84-168] months) were enrolled. HE was present in 50 (31.2%) patients with a total of 61 episodes. Maximum grade of HE was grade I (n = 16), II (n = 23), III (n = 11) and IV (n = 11). Forty-two cases had single and 8 had recurrent (2-5) episodes. Median duration of HE episodes was 96 (72-192) hours. Precipitants were identified in 55/61 (90.2%) episodes with infection (45/61, 73.7%) and dyselectrolytemia (33/61, 54%) being the most common. Lower albumin and sodium, higher INR and presence of infection were significantly associated with presence of HE. Overall, HE resolved in 33 (54%) episodes, while it progressed and persisted in 28 (45.9%) episodes. Patients with HE had a poorer outcome (25/50 vs 13/110; < 0.01) with both higher in-hospital (11/50 vs 9/110; = 0.02) and 1-month post discharge (14/39 vs 4/101; < 0.01) mortality than those without HE.
One-third of admitted CLD children have HE, with identifiable precipitants in 90% of cases. Children with HE have poorer liver functions, higher rate of infections and worse outcome than those without HE.
肝性脑病（HE）是成人慢性肝病（CLD）预后不良的一个指标。由于关于儿童CLD中HE的文献较少，我们对其患病率和诱因进行了前瞻性研究。
对收治的1-18岁CLD患儿每天检查是否存在HE及其分级（韦斯特黑文/惠廷顿分级）。诱因分为感染、电解质紊乱、胃肠道出血、便秘和脱水。记录HE分级变化及转归情况。
共纳入160例儿童（年龄120[84-168]个月）。50例（31.2%）患者存在HE，共61次发作。HE最高分级为I级（n = 16）、II级（n = 23）、III级（n = 11）和IV级（n = 11）。42例为单次发作，8例有复发（2-5次）发作。HE发作的中位持续时间为96（72-192）小时。55/61（90.2%）次发作中发现了诱因，其中感染（45/61，73.7%）和电解质紊乱（33/61，54%）最为常见。较低的白蛋白和钠水平、较高的国际标准化比值（INR）以及感染的存在与HE的发生显著相关。总体而言，33次（54%）发作中HE得到缓解，而28次（45.9%）发作中HE进展并持续。与无HE的患者相比，HE患者的预后较差（25/50对13/110；P<0.01），住院死亡率（11/50对9/110；P = 0.02）和出院后1个月死亡率（14/39对4/101；P<0.01）均更高。
三分之一的住院CLD儿童患有HE，90%的病例有可识别的诱因。与无HE的儿童相比，HE儿童的肝功能较差、感染率较高且预后较差。
