Abstract

ABSTRACT:
BACKGROUND:
Fulminant hepatic failure (FHF) is one of the most challenging pediatric emergencies encountered in clinical practice and encompasses a pattern of clinical symptoms and pathophysiological responses associated with the rapid arrest of normal hepatic function. Major differences exist in etiology of FHF between western & eastern countries.
OBJECTIVE:
To study etiologies, prognostic factors and the outcome of Fulminant Hepatic Failure in a sample of Iraqi children.
PATIENTS AND METHODS:
A prospective study was done on (31) patients with (FHF) admitted to the Gastroenterology and Hepatology unit in Children Welfare Teaching Hospital (During the period from January 2010- January 2011). The patients referred to our center from all over Iraq.The diagnosis of FHF was based on the presence of biochemical evidence of acute liver injury (elevated plasma transaminases), associated with PT > 15 seconds, not corrected by vitamin K, in the presence of clinical hepatic encephalopathy, or PT > 20 seconds with or without clinical hepatic encephalopathy in a patient previously healthy or have well compensated liver disease. Detailed history, clinical examination, routine biochemical parameters, and relevant diagnostic test carried out to all patients.
RESULTS:
During the study period, (31) patients admitted with the diagnosis of FHF. Eighteen males (58.1%) and 13 females (41.9%), the most common affected age group was toddlers. The mean age of the study population was (2.93± 1.06).The most common etiology was viral in 15(48.3%) cases. {10(32.2%) had HAV}, 3(18%) had HBV, and 2(6.5%) had HEV} viruses, 2(6.5%) had CMV & 1(3.2%) had herpes virus hepatitis. Two (6.5%) had Galactosemia, 2(6.5%) had Wilson's disease and 2(6.5%) had autoimmune hepatitis. Etiology could not be established in 5(16.1%) of cases .Twenty patients died with death rate of (64.5%).
CONCLUSION:
The study indicates that Hepatitis A was the most common cause of FHF with high mortality rate. Those who died were younger, suffered GI bleeding, a higher grade of encephalopathy, longer duration of illness before onset of encephalopathy, prothrombin time > 41seconds, had higher bilirubin & lower SGPT, lower albumin, & lower blood sugar.