Clinico-aetiological profile, risk factors for decompensation and outcomes in paediatric chronic liver disease: a retrospective cohort study from a tertiary care centre in South India

Background Chronic liver disease (CLD) in children encompasses a heterogeneous group of disorders with aetiologies that differ significantly from adults. Data from low- and middle-income countries, particularly India, remain limited, especially regarding determinants of decompensation and outcomes. Methods A retrospective observational study was conducted at a tertiary care centre in South India including children aged 3 months to 18 years admitted with CLD between January 2017 and December 2022. Clinical presentation, nutritional status, aetiology, decompensation profile, investigations, complications and outcomes were analysed. Decompensation was defined as the presence of ascites, hepatic encephalopathy or gastrointestinal bleeding. Statistical analysis was performed using SPSS v21.0; chi-square and Fisher’s exact tests were applied for categorical comparisons, with p < 0.05 considered significant. Results Ninety-eight children were included with equal gender distribution. Wilson disease (36.7%) and extrahepatic biliary atresia (EHBA, 28.6%) were the leading aetiologies. Decompensation occurred in 80.6% of children; hyponatraemia (36.7%), sepsis (35.4%), gastrointestinal bleeding (34.2%) and pneumonia (31.6%) were the most frequent precipitants. Malnutrition was present in 62.2% of patients. Overall mortality was 20.4%. Aetiology-specific mortality differed significantly (χ²=12.47, p = 0.014), being highest in EHBA (35.7%). On univariable analysis, recurrent decompensation (≥ 2 episodes) was associated with higher mortality ( p = 0.032). Conclusion Paediatric CLD presents with advanced disease and a high burden of decompensation in this setting. Early diagnosis, nutritional optimisation and prompt management of infections and electrolyte disturbances are essential to improve outcomes. Aetiology-specific surveillance and structured decompensation protocols should be prioritised.