title: Hepatotropic viruses as etiological agents of acute liver failure and related-outcomes among children in India: a retrospective hospital-based study.
abstract: BACKGROUND
  Acute liver failure (ALF) is marked by a sudden loss of hepatic function and is associated with a high mortality rate in children. The etiology of ALF is shown to vary geographically. This study assessed the frequency of hepatotropic viruses as etiological agents of ALF in Indian children.
  
  
  METHODS
  This retrospective study enrolled children aged 0-18 years with confirmed ALF admitted to Christian Medical College, Vellore and King Edward Memorial Hospital and Research Center, Pune between January 2003 and December 2005. The frequency of hepatotropic viruses as etiological agents in children with ALF aged ≤18 years was calculated with 95% confidence interval (CI). Descriptive analyses of demographic characteristics, clinical signs and symptoms of ALF, choice of treatment and outcomes were performed.
  
  
  RESULTS
  Of 76 children enrolled, 54 were included in the per-protocol analyses. Mean age of children with ALF was 5.43 years (standard deviation = 3.62); 51.9% (28/54) were female. The percentage of children positive for anti-hepatitis A virus (HAV) IgM and hepatitis B surface antigen was 65.9% (27/41; 95% CI 49.4-79.9) and 15.9% (7/44; 95% CI 6.6-30.1), respectively. The final cause of ALF was HAV (36.3%) followed by hepatitis B virus (HBV; 8.8%). Before and during admission, encephalopathy was observed in 77.8% (42/54) and 63.0% (34/54) of children, respectively. A high number of children (46/54; 85.2%) required intensive care and ALF was fatal in 24.1% (13/54). The proportion of deaths due to HAV and HBV was 18.5% (5/27) and 57.1% (4/7), respectively.
  
  
  CONCLUSIONS
  HAV and HBV were the most common etiological agents of ALF in Indian children. Primary prevention by vaccination against HAV and HBV in young children may be useful in the prevention of ALF due to viral hepatitis in India.
authors: Department of Pediatrics and Neonatology, King Edward Memorial Hospital, Sardar Mudaliar Road, Rasta Peth, Pune, 411011, India. kemhrc@vsnl.net.
authors: Anand
authors: A
authors: Pandit
authors: Christian Medical College, Vellore Child Health Unit 1, Vellore, 632004, India. lenimathew@cmcvellore.ac.in.
authors: Leni Grace
authors: LG
authors: Mathew
authors: Department of Pediatrics and Neonatology, King Edward Memorial Hospital, Sardar Mudaliar Road, Rasta Peth, Pune, 411011, India. bavdekar@vsnl.com.
authors: Ashish
authors: A
authors: Bavdekar
authors: GlaxoSmithKline Pharmaceuticals, Dr. Annie Besant Road, Worli, Mumbai, 400 030, India. shailesh.i.mehta@gsk.com.
authors: Shailesh
authors: S
authors: Mehta
authors: GlaxoSmithKline Pharmaceuticals, #5 Embassy Links, SRT road, Bangalore, 560052, India. gunasekaran.c.ramakrishnan@gsk.com.
authors: Gunasekaran
authors: G
authors: Ramakrishnan
authors: GlaxoSmithKline Vaccines, Rue Fleming 20, 1300, Wavre, Belgium. sanjoy.k.datta@gsk.com.
authors: Sanjoy
authors: S
authors: Datta
authors: GlaxoSmithKline Vaccines, 150 Beach Road, #22-00 Gateway West, Singapore, 189720, Singapore. yanfangliu@hotmail.com.
authors: Yan Fang
authors: YF
authors: Liu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D030041:Hepatitis A virus / Q000472:pathogenicity*; D006515:Hepatitis B virus / Q000472:pathogenicity*; D006761:Hospitals; D006801:Humans; D007194:India; D017114:Liver Failure, Acute / Q000503:physiopathology / Q000628:therapy / Q000821:virology*; D008111:Liver Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome