Therapeutic plasma exchange and continuous renal replacement therapy in pediatric dengue-associated acute liver failure: A case series from Vietnam. (April 2023)

• Record Type: Journal Article
• Authors: Thanh, Nguyen Tat; Dat, Nguyen Tat; Thinh, Tran Ngoc; Phuong, Ngo Thi Mai; Thanh, Mai Thi Hoai; Bao, Nguyen Trung; Son, Pham Thai; Viet, Do Chau; Tung, Trinh Huu; Thien, Vu; Luan, Vo Thanh
• Is Part Of: Transfusion and apheresis science. Volume 62:Number 2(2023)
• Publication Date: 2023-04
• Subjects: PALF paediatric acute liver failure -- TPE therapeutic plasma exchange -- CRRT continuous renal replacement therapy -- PRISM Paediatric Risk of Mortality -- pSOFA Pediatric Sequential Organ Failure Assessment -- AST aspartate aminotransferase -- ALT alanine aminotransferase -- INR international normalised ratio; Continuous renal replacement therapy -- Dengue -- Pediatric acute liver failure -- PALF -- Therapeutic plasma exchange -- Vietnam; Blood -- Transfusion -- Periodicals; Hemapheresis -- Periodicals; 615.39
• DOI: 10.1016/j.transci.2022.103617
• Languages: English
• ISSNs: 1473-0502

Abstract

Abstract: Background and objectives: Paediatric dengue-associated acute liver failure (PALF) is a rare and fatal complication. To date, clinical data regarding the combination of therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) for the treatment of dengue-associated PALF are limited. Methods: We conducted a single-center, retrospective study of all children with dengue-associated PALF admitted to the paediatric intensive care unit of Children Hospital No.2, Vietnam, who were treated with TPE+CRRT between January 2021 and March 2022. The main study outcomes were in-hospital survival, normalisation of hepatic function, and hepatic encephalopathy improvement. Results: Twelve patients aged from 06 to 12 years underwent TPE+CRRT procedures. Among them, three (25 %) patients died of severe sepsis and septic shock confirmed by Enterobacteriaceae spp. haemocultures (stable on maintenance treatment of COVID-19-associated MIS-C with low dose of oral steroids on hospital admission), acute respiratory distress syndrome (ARDS), and clinically apparent intracranial haemorrhage. Nine patients (75 %) survived. The paediatric mortality risk score improved significantly at discharge compared with PICU admission ( P < 0.01). Markedly, all twelve patients were diagnosed with hepatoencephalopathy of grades III and IV on PICU admission. After the combined TPE+CRRT interventions, there were substantial improvements in liver transaminases levels, coagulation profiles, and metabolic biomarkers. Normal neurological functions were observed in nine alive patients at hospital discharge. Only one patient experienced an adverse event of slightly low blood pressure, which rapidly self-resolved. Interpretation and conclusions: Combined TPE+CRRT significantly improved survival outcome, neurological status, and rapid normalisation of liver functions in dengue-associated PALF. Highlights: Paediatric dengue-associated acute liver failure (PALF) is a rare and fatal complication. Pediatric mortality risk score improved significantly in patients treated with CRRT+TPE. Substantial improvements in liver transaminases levels, coagulation profiles, and metabolic biomarkers and clinical hepatoencephalopathy. Nine in twelve patients (75 %) survived, and alive patients completely recovered with normal neurological functions. A proposal of indication for commencing the combined TPE and CRRT interventions in children with dengue-associated PALF.