Bahawal Uddin Jamro, Salah Muhammad Channa, Pirbho Mal Makheja, Aftab Ahmed Soomro.
Etiology, outcome and risk factors for fulminant hepatic failure in children at a tertiary care hospital, Sukkur, Pakistan.
Rawal Med J Jan ;38(3):219-22.

Objective: To study the etiology, outcome and risk factors for Fulminant Hepatic Failure (FHF) in children at a tertiary care hospital, Sukkur. Methodology: Retrospective review of patients 1-14years, admitted with FHF from July 2007 to June 2012, at Pediatric department of Ghulam Muhammad Mahar Medical College Hospital Sukkur. Fulminant hepatic failure was defined as coagulopathy (PT > 20 sec or INR > 2) with or without hepatic encephalopathy within 8 weeks of the onset of symptoms. Results: Eighty patients with FHF (50 males and 30 females) were admitted in our Pediatric department. The most common cause of FHF was viral hepatitis in 62 (77.5%) and in 11 (13.75%) cases etiology was not established. Among 62 cases of viral hepatitis, HAV was found in 50 (80.65%), and HBV in 11 (17.74%). Encephalopathy grade 3 was most common in 30 (37.50%), and grade 2 in 25 (31.25%). Forty five (56.25%) patients expired. Patients with bilirubin 13.0±8.0 mg/dl vs 6.7±3.3 mg/dl recovered. ALT was lower in expired patients 467±381 IU/L vs 1834.3±1550.2 IU/L in recovered children. 45 (52%) expired with INR of 4 or more. The risk factors of FHF patients were grade 3 or 4 encephalopathy, high bilirubin, low ALT and INR >4. Conclusion: HAV and HBV were the most common etiologic agents of FHF. Children with FHF, high grade encephalopathy, high bilirubin, low ALT and INR >4 had poor outcome. (Rawal Med J 2013;38: 219-222).

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