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Abstract
Background and objective: The liver is a key player in critical illness. Several studies on hepatic dysfunction in critically ill adult patients proved the significant impact of hepatic dysfunction on patients{u2019} morbidity and mortality. We conducted this study to address this problem in the pediatric population. We studied the frequency, risk factors and outcomes of hepatic dysfunction in critically ill children. Study design: This is a single center prospective analytical study Patients and methods: Patients were recruited from a 10-bed pediatric intensive care unit (PICU) at Cairo University Specialized Children Hospital. All patients admitted to this PICU in the period from April to December 2015 were included. Patients were followed up until they were discharged from or died in the PICU. Hepatic dysfunction was defined as any abnormality in liver function tests. Results: One hundred and fifty-one patients were included in this study. Ten patients (6.6%) were admitted with primary hepatic dysfunction. Patients with primary hepatic dysfunction were significantly associated with mortality (p< 0.001) but did not increase the length of stay (LOS) in PICU. Forty-three patients (28.5%) acquired secondary hepatic dysfunction during their PICU stay. Several risk factors were significantly associated with secondary hepatic dysfunction: malnutrition (p= 0.03), sepsis (p<0.001), cardiovascular events (p<0.001), hypoxia (p<0.001), use of inotropes (p<0.001) and mechanical ventilation (p=0.001), while surgery was not significantly associated with hepatic dysfunction. Independent risk factors of mortality in logistic regression analysis were cardiovascular events (p=0.009), mechanical ventilation (p=0.007) and multiple organ dysfunctions (p=0.37), while sepsis was significantly associated with prolonged LOS in PICU (p=0.005)