Etiology And Prognostic Risk Factors Of Acuteliver Failure In Children

Objective:Explore the distribution of causes of acute liver failure in children and analyze related risk factors that affect the prognosis of acute liver failure in children.Methods:Collect the clinical data of children diagnosed with acute liver failure in Kunming Children’s Hospital from November 2016 to September 2020.According to the prognosis,they are divided into effective and ineffective groups.The etiology,main clinical manifestations and prognosis are analyzed,and the two groups are compared.The relationship between differences in biochemical indicators and clinical manifestations and prognosis.The statistical methods are mainly analyzed by EXCEL2016 and SPSS21.0.Results:（1）A total of 64 children with liver failure,27 males and 37 females;aged from 1 month to 15.5 years old,of which 30 cases were in the effective group（including 1 case with improved liver transplantation）and 34 cases were in the invalid group（including 4 cases were discharged automatically）).（2）Among the known causes,17/36 cases of poisoning（47.2%）,9/36 cases of infection（25.0%）,4/36 cases of genetic metabolism（11.1%）,and 1/36 cases of autoimmune diseases（2.78%）),1/36 cases of pelvic rhabdomyosarcoma（2.78%）,1/36 cases of fulminant myocarditis（2.78%）,1/36 cases of Kawasaki disease（2.78%）,and 1/36 cases of common bile duct dilation（2.78%）%),1/36 cases of biliary atresia（accounting for 2.78%）,28/64 cases of unknown etiology（accounting for 43.8%）.（3）The case fatality rate in this case study was 53.13%.Toadstool poisoning due to known causes had the highest mortality rate of 57.14%, followed by infection, which was 44.44%; （4） Toadstool poisoning accounted for the highest proportion in the preschool period (85.7%》; （5）Compared with the effective group in single factor analysis, the difference in the number of complications, TBIL, PT, APTT, VBC, NH₃, serum creatinine, and alpha-fetoprotein in the ineffective group was statistically significant; the difference in PTA and hospitalization days decreased There is statistical significance （P<0.05）.Conclusion :（1） The causes of acute liver failure in children can be roughly divided into the following categories: ① infection,② poisoning,③ genetic metabolism,④autoimmunity,⑤ blood vessels and tumors,⑥ others. Acute liver failure in children with unknown causes still accounts for a large proportion of all age groups. Among the known causes, the most common cause of acute liver failure in children is drug/other poisoning; the most common cause in infancy is infection; preschool and school age The incidence of poisoning is the highest; genetic metabolic diseases can occur at all ages.（2） The use rate of blood purification in children with acute liver failure caused by drug and toadstool poisoning is the highest, and there is no statistical significance between the effective group and the ineffective group between blood purification treatment and drug treatment（3） The mortality rate of children with acute liver failure is relatively high, and the mortality rate of mushroom poisoning from known causes is the highest, followed by infection.（4） The prognosis of children with acute liver failure is related to complications. The greater the number of complications, the worse the prognosis.（5） High Tbil and complicated respiratory failure are independent risk factors for poor prognosis of children with acute liver failure.