Prediction of Early Liver Failure in Pediatric Patients Admitted to Intensive Care Unit

• Published in: Middle East journal of digestive diseases 2019-07, Vol.11 (3), p.141-146
• Main Authors: Zahmatkeshan, Mozhgan, Serati, Zahra, Freydooni, Shole, Safarpour, Ali Reza, Esmailnejad, Atefeh, Haghbin, Saeede
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Enzymes; Hepatic dysfunction; Hepatitis; Hospitals; Hypoxia; Illnesses; Intensive care; Intensive care units; Laboratories; Liver diseases; Metabolism; Mortality; Original; Pediatric; Pediatrics; Phosphatase; Physiology; Sepsis
• ISSN: 2008-5230; 2008-5249
• DOI: 10.15171/mejdd.2019.140

Determining the prognosis of the patients is also useful for choosing the most effective treatments, which can lead to better clinical results.1,3 Based on the different markers that have been used as indicators of hepatic dysfunction, the prevalence of liver failure was reported to vary from 6% to 61% on the first day of admission in adult ICUs.2 Since bilirubin has been used as a key indicator of liver dysfunction in ICU critical illness scoring systems including Simplified "Sequential Organ Failure Assessment (SOFA)" score and "Simplified Acute Physiology Score (SAPS)", it has been the main focus of literature with regard to the liver failure.4 Previous studies have revealed that elevated serum bilirubin > 2 mg/dL was linked to the severity of illness and had a negative effect on both mortality and length of stay.4,5 As clinical jaundice develops only several days after hepatic injury ensues, liver dysfunction has been considered as a late event in sepsis and multi-organ failure.1 Moreover, it was seen that abnormal aspartate aminotransferase (AST), alkaline phosphatase (AKP), and gamma glutamyl transferase were correlated with increased risk of mortality within 30 days of admission in ICU.2 Therefore, early liver dysfunction is a subtle but prevalent phenomenon in adult critical illnesses and is associated with poor outcomes. ALT, TBILI, DBILI, and INR were also considered abnormal if they were higher than the upper limit of the laboratory levels. Because all the measurements were performed as a part of the routine metabolic evaluation of the patients and the confidentiality procedures were maintained, the requirement for informed consent was waived for the admission PICU profile, but written informed consents were obtained from the parents or guardians in case of repeated tests needed 48 and 96 hours after admission. After 48 hours, the probability of death was still significantly higher in the groups with abnormal serum ALT, TBILI, DBILI, and INR levels (table 3) and after 96 hours, patients with abnormal TBILI, DBILI, and INR had a higher rate of mortality compared with those with normal test results. [...]in univariate analysis, patients with abnormal AST level were still 5.6 times more likely to die compared with those with normal results (OR: 5.6, 95% CI: 1- 29.7, P < 0.03) (table 4). [...]the number of participating patients declined gradually 96 hours after admission and their data were not considered in statistical analysis.