Clinical Characteristics And Risk Factor Analysis Of Liver Injury After Intravenous Injection Of Methylprednisolone In Children

Research backgroundMethylprednisolone is a synthetic glucocorticoid drug widely used in clinical practice for neuroimmune related diseases.However,methylprednisolone may cause serious liver damage,resulting in adverse consequences.At present,there is no clear definition of the clinical characteristics and risk factors of liver injury caused by high-dose methylprednisolone in children.ObjectiveTo analyze the clinical characteristics and related risk factors of liver injury caused by intravenous high-dose methylprednisolone(IVMP)in children,and to provide clinical evidence for the risk assessment and treatment of liver injury after IVMP treatment.Method1.Clinical data of 129 children who received IVMP shock therapy in the pediatric neurological ward of Shandong University Qilu Hospital from January 2016 to October 2022 were collected,including name,gender,height,weight,primary disease,past history,length of stay,imaging results,etc.2.Liver function indexes such as alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),glutamyl transpeptidase(GGT),total bilirubin(TBIL),prealbumin(PA),albumin(ALB),and ceruloplasmin(CP)were analyzed before and after treatment.3.According to the results of liver function after IVMP shock therapy,divided into "liver function injury group" and "liver function normal group",according to RousselUclaf causality evaluation method(RUCAM),from the "liver function injury group" screened out"IVMP-related liver injury" patients,The clinical characteristics of children with IVMP-related liver injury and the changes of liver function indexes before and after IVMP treatment were analyzed.Compared with the clinical data of "normal liver function group",the risk factors of IVMP-related liver injury were analyzed.Result1.129 patients,86 patients with normal liver function,accounting for 66.67%of the total number;43 cases had abnormal liver function,accounting for 33.33%of the total number.After RUCAM evaluation,IVMP-related liver injury was identified in 40 cases,accounting for 31.01%of the total number.2.Among the children with IVMP-related liver injury,27.50%(11/40)suffered severe liver injury(ALT>120U/L)and 72.50%(29/40)suffered mild liver injury(40<ALT≤120U/L).3.The levels of ALT,AST,ALP,PA and ALB in children with IVMP-related liver injury were statistically different before and after I VMP shock therapy(P<0.01),and the levels of ALT,AST,GGT and PA after IVMP shock therapy were higher than those before IVMP shock therapy.ALP and ALB levels were lower than those before IVMP shock therapy;There was no significant difference in TBIL level before and after IVMP shock therapy(P>0.05).4.There was a statistical difference in CP level before and after IVMP shock therapy(P<0.01),and CP level after IVMP shock therapy was significantly lower than that before treatment.Compared with ALT,CP showed slightly higher sensitivity to liver function injury than ALT,but there was no statistical significance(P>0.05).5.Compared with the normal liver function group,the children in the IVMP-related liver injury group were older and the total dose of methylprednisolone was higher,both of which had statistical significance(P<0.01).There was no statistical significance in BMI,primary disease,length of stay,previous history of MP shock and liver injury,and immunosuppressive use(all P>0.05).6.Univariate Logistic regression analysis showed that age≥10 years(P<0.01),BMI≥20 years(P<0.05),and methylprednisolone cumulative dose≥5g(P<0.01)were risk factors for IVMP-related liver injury.The above risk factors were included in the multivariate Logistic regression equation,and the results showed that age≥10 years old(OR=3.358,95%CI:1.416-7.961;P<0.01)was a risk factor for liver injury after IVMP shock therapy.Conclusion1.Ivmp-related liver injury was mainly mild liver injury,and the vast majority of patients could recover to normal after self-treatment or drug treatment.2.Age≥10 years old was an independent risk factor for IVMP-related liver injury.3.For children with IVMP shock therapy,the changes in liver function of children should be dynamically monitored,so as to detect drug-induced liver injury as early as possible,and timely treatment.