Kehar Mohit, Black Katherine, Chu Christopher, Kohli Rohit, Mohammad Saeed
Division of Pediatric Gastroenterology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
J Pediatr Gastroenterol Nutr. 2025 Aug;81(2):177-182. doi: 10.1002/jpn3.70083. Epub 2025 May 19.
Clusters of severe acute hepatitis in children were reported worldwide beginning in October 2021. Although most children recovered, some progressed to liver failure leading to death or liver transplantation. Herein, we characterize the clinical characteristics, and outcomes of this group of children through an international collaborative effort.
Participation was solicited via a global listserv to pediatric gastroenterologists worldwide. Patients <18 years, alanine aminotransferase >500 U/L, without chronic liver disease or acetaminophen ingestion were eligible. Data were submitted by individual sites into a Research Electronic Data Capture registry created in July 2022.
Two hundred and seven cases were collected, with a peak incidence of 28 in April 2022. The median age was 40 months, 52.7% were male, 63.3% were white, and 44% were Hispanic. At presentation, 80% reported gastrointestinal symptoms followed by fever (27.7%). The median duration of hospitalization was 5.5 days with 51 patients requiring intensive care. Adenovirus serum/whole blood DNA was detected in 28/133 (21%) and seven patients were treated with cidofovir. Liver biopsies, performed in 76 patients revealed portal and lobular inflammation with none identifying a viral etiology. Eleven patients underwent liver transplantation, four were adenovirus positive, all of whom survived. There were four reported deaths.
In this large data set of pediatric patients with severe acute hepatitis, the majority did not have a singular definitive etiology but did recover spontaneously. Continued community surveillance and close cooperation are critical toward understanding the etiology of such clusters in pediatrics.
2021年10月起，全球报告了多起儿童重症急性肝炎病例群。尽管大多数儿童康复，但部分儿童进展为肝衰竭，导致死亡或接受肝移植。在此，我们通过国际合作努力，对这组儿童的临床特征和结局进行描述。
通过全球儿科胃肠病学家邮件列表征集参与者。年龄<18岁、丙氨酸转氨酶>500 U/L、无慢性肝病或未服用对乙酰氨基酚的患者符合条件。各研究点将数据提交至2022年7月创建的研究电子数据采集登记系统。
共收集到207例病例，2022年4月发病率达到峰值28例。中位年龄为40个月，52.7%为男性，63.3%为白人，44%为西班牙裔。就诊时，80%的患儿报告有胃肠道症状，其次是发热（27.7%）。中位住院时间为5.5天，51例患者需要重症监护。133例中有28例（21%）检测到腺病毒血清/全血DNA，7例患者接受了西多福韦治疗。76例患者进行了肝活检，显示门静脉和小叶炎症，均未发现病毒病因。11例患者接受了肝移植，4例腺病毒阳性，均存活。报告有4例死亡。
在这个大型儿童重症急性肝炎数据集中，大多数病例没有单一明确的病因，但均自发康复。持续的社区监测和密切合作对于了解儿科此类病例群的病因至关重要。
