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Abstract Background Secondary hepatic dysfunction is a common finding in PICU with a frequency of 28.5% and it’s significantly associated with high mortality and prolonged ICU stay. Patterns of liver cell injury in critically ill pediatric patients can be contributed to hemodynamic, metabolic and inflammatory factors. Such as septic shock, hemorrhagic shock, cardiogenic shock, acute respiratory affection, multi-organ failure, hepatitis of infective origin or iatrogenesis such as parenteral nutrition, blood product transfusion and hepatotoxic medications. Aim of the Work To assess the frequency of liver functions impairment in PICU population, potential risk factors and its impact on clinical outcome in critically ill patients regarding its prognostic relevance. Patients and Methods This single-center, retrospective analytical study was conducted at the 24-bed Pediatric Intensive Care Unit (PICU) of Ain Shams University Children Hospital. this study included 420 patients, aged from 1 month – 15 years. All critically ill patients admitted to PICU between December 2023 and May 2024 were included in the study. Secondary hepatic dysfunction was defined as the development of abnormal liver functions in a patient without a previous liver disease during intensive care unit stay according to lab findings upon predefined values after exclusion of solitary abnormal values. Patients were excluded if a pre-existing cause that would alter baseline liver functions as: metabolic disorder or primary liver disease was present. The following data were collected: age, gender, indication of admission, type of organ dysfunction, presence of sepsis and pediatric Sequential Organ Failure Assessment (pSOFA) Score, shock, need for cardiovascular or respiratory support, administered medications. Laboratory data were collected on admission, day 3, and day 7, or until the patients were either discharged or died during their stay in the PICU. Results Four-hundred and twenty were included. One hundred thirty-seven patients (32.62%) developed secondary hepatic dysfunction. Several risk factors were significantly associated with secondary hepatic dysfunction: sepsis (p 0.001), cardiovascular events (p 0.001), invasive mechanical ventilation (p 0.001) and exposure to cardiac pulmonary arrest during admission (P = 0.001), use of inotropes (p 0.001), transfusion of blood products (P = 0.001), use of antifungals (p 0.001) and sedatives (p 0.001). Secondary hepatic dysfunction was associated with prolonged PICU stay and risk of mortality. Conclusion Hepatic dysfunction is an independent predictor of mortality and prolonged length of stay. During admission, patients with early elevation of transaminases should be vigilantly monitored.
Magdy et al. (Sat,) studied this question.