title: Analysis of viral testing in nonacetaminophen pediatric acute liver failure.
abstract: OBJECTIVE
  Viral infections are often suspected to cause pediatric acute liver failure (PALF), but large-scale studies have not been performed. We analyzed the results of viral testing among nonacetaminophen PALF study participants.
  
  
  METHODS
  Participants were enrolled in the PALF registry. Diagnostic evaluation and final diagnosis were determined by the site investigator and methods for viral testing by local standard of care. Viruses were classified as either causative viruses (CVs) or associated viruses (AVs). Supplemental testing for CV was performed if not done clinically and serum was available. Final diagnoses included "viral," "indeterminate," and "other."
  
  
  RESULTS
  Of 860 participants, 820 had at least 1 test result for a CV or AV. A positive viral test was found in 166/820 (20.2%) participants and distributed among "viral" (66/80 [82.5%]), "indeterminate" (52/420 [12.4%]), and "other" (48/320 [15.0%]) diagnoses. CVs accounted for 81/166 (48.8%) positive tests. Herpes simplex virus (HSV) was positive in 39/335 (11.6%) who were tested 26/103 (25.2%) and 13/232 (5.6%) among infants 0 to 6 and >6 months, respectively. HSV was not tested in 61.0% and 53% of the overall cohort and those 0 to 6 months, respectively. Supplemental testing yielded 17 positive, including 5 HSV.
  
  
  CONCLUSIONS
  Viral testing in PALF occurs frequently but is often incomplete. The evidence for acute viral infection was found in 20.2% of those tested for viruses. HSV is an important viral cause for PALF in all age groups. The etiopathogenic role of CV and AV in PALF requires further investigation.
authors.affiliation: *Department of Pediatrics, Johns Hopkins University School of Medicine, Division of Gastroenterology and Nutrition, Charlotte R. Bloomberg Johns Hopkins Children's Center, Baltimore, MD †Liver Unit, Birmingham Children's Hospital, Birmingham, UK ‡Department of Pediatrics, Columbia University School of Medicine, Division of Gastroenterology, New York, NY §Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Division of Pediatric Gastroenterology, Ann Arbor ||Department of Pediatrics, University of Texas Southwestern Medical Center, Division of Gastroenterology, Dallas ¶Department of Pediatrics, University of Cincinnati College of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH #Department of Epidemiology **Department of Pediatrics, University of Pittsburgh School of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Schwarz
authors.forename: Dominic
authors.initials: D
authors.lastname: Dell Olio
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lobritto
authors.forename: M James
authors.initials: MJ
authors.lastname: Lopez
authors.forename: Norberto
authors.initials: N
authors.lastname: Rodriguez-Baez
authors.forename: Nada A
authors.initials: NA
authors.lastname: Yazigi
authors.forename: Steven H
authors.initials: SH
authors.lastname: Belle
authors.forename: Song
authors.initials: S
authors.lastname: Zhang
authors.forename: Robert H
authors.initials: RH
authors.lastname: Squires
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D006561:Herpes Simplex / Q000150:complications / Q000175:diagnosis / Q000821:virology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology / Q000821:virology*; D016133:Polymerase Chain Reaction; D018139:Simplexvirus / Q000235:genetics / Q000276:immunology
chemical_list: D000914:Antibodies, Viral