Published online Dec 9, 2024. doi: 10.5492/wjccm.v13.i4.98862
Revised: September 26, 2024
Accepted: October 20, 2024
Published online: December 9, 2024
Processing time: 115 Days and 7.9 Hours
Dengue-associated acute liver failure (PALF) accounts for a high mortality rate in children admitted to the pediatric intensive care unit (PICU). To date, there is a lack of data on clinical algorithms for estimating the risk of mortality in pediatric patients with dengue-induced severe hepatitis (DISH).
To determine the prevalence of PALF and identify the predictors of mortality among patients with DISH.
This single-institution retrospective study was performed at a tertiary pediatric hospital in Vietnam between 2013 and 2022. The primary outcome was in-hospital mortality in pediatric patients with DISH, which was defined as either aspartate aminotransferase > 350 IU/L or alanine aminotransferase > 400 IU/L. Prognostic models for estimating the risk of death among patients with DISH were deve
A total of 459 children with DISH were included in the analysis. The median patient age was 7.7 years (interquartile range: 4.3-10.1 years). The prevalence of dengue-associated PALF in children with DISH was 18.3%. Thirty-nine DISH patients developing PALF (8.5%) died. Hepatic biomarkers, including the international normalized ratio (INR) ≥ 2.11 and total serum bilirubin (≥ 1.7 mg/dL), showed high predictive values for mortality (all P values < 0.001). Multivariable models showed the significant clinical predictors of death from dengue-induced PALF in patients with DISH, including reduced level of consciousness (pain and unresponsive levels on the Alert, Verbal, Pain, Unresponsive scale), high vasoactive-inotropic score (> 30), and elevated levels of blood lactate, INR, and serum bilirubin. The final prognostic model demonstrated high discrimination, Brier score, and an acceptable calibration slope.
The prevalence of PALF in children with DISH is 18.3%. We developed robust prognostic models to estimate the risk of death in hospitalized children with severe dengue-induced hepatitis.
Core Tip: The prevalence of dengue-associated acute liver failure in children with dengue-induced severe hepatitis (DISH) was 18.3%. The in-hospital mortality rate was approximately 8.5% among DISH patients developing acute liver failure. Hepatic biomarkers, including international normalized ratio (INR) (≥ 2.11) and total serum bilirubin (≥ 1.7 mg/dL), showed high predictive values for mortality. The significant predictors of mortality in children with DISH were decreased level of consciousness (pain and unresponsive levels on the Alert, Verbal, Pain, Unresponsive scale), high vasoactive-inotropic score (> 30), elevated blood lactate and INR levels during the first 24 hours of pediatric intensive care unit admission, and rising serum bilirubin during the first 72 hours of admission.