Predicting the risk of mortality in children with dengue-induced hepatitis admitted to the paediatric intensive care unit  

作　　者：Thanh Tat Nguyen Phuong Thi-Mai Ngo Luan Thanh Vo 

机构地区：[1]Department of Tuberculosis,Woolcock Institute of Medical Research,Ho Chi Minh 700000,Viet Nam [2]Department of Infectious Diseases,The Children’s Hospital 2,Ho Chi Minh 700000,Viet Nam

出　　处：《World Journal of Critical Care Medicine》2024年第4期51-61,共11页世界重症医学杂志（英文）

基　　金：approved by the Scientific Committee and Institutional Review Board of the Children’s Hospital 2,Ho Chi Minh City,Vietnam(approval No.391/QD-BVND2,March 22,2022).

摘　　要：BACKGROUND 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).AIM To determine the prevalence of PALF and identify the predictors of mortality among patients with DISH.METHODS 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 developed using a predefined set of clinical covariables and hepatic biomarkers on PICU admission and during the first 72 hours of admission.Area under the curve,multivariable logistic regression,and multiple imputation using the chained equation for missing values were performed.Backward stepwise model selection based on the Akaike information criterion was employed.Bootstrapping,calibration slope,and Brier score were used to assess the final models.RESULTS 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.Th

关 键 词：DENGUE Dengue-associated acute liver failure Dengue-induced severe hepatitis Dengue shock syndrome Hepatic encephalopathy MORTALITY 

分 类 号：R512.8[医药卫生—内科学] R47[医药卫生—临床医学] R72