PDF(Pubmed)
Abstract：
UNASSIGNED: In a prior report, no patient with rodenticidal hepatotoxicity who met Kochi criteria (MELD score ≥36 or baseline INR ≥6 with hepatic encephalopathy) (PMID: 26310868) for urgent liver transplantation survived with medical management alone. Plasma exchange (PLEX) may improve survival in these patients.
UNASSIGNED: We describe our experience with low-volume PLEX (PLEX-LV) in treating rodenticide ingestion induced hepatotoxicity in children.
UNASSIGNED: From prospectively collected database of rodenticidal hepatotoxicity patients managed as in-patient with department of Hepatology from December 2017 to August 2021, we retrospectively studied outcomes in children (≤18 years). Hepatotoxicity was categorized as acute liver injury (ALI, coagulopathy alone) or acute liver failure (ALF, coagulopathy and encephalopathy). Kochi criteria was used to assess need for urgent liver transplantation. The primary study outcome was one-month survival.
UNASSIGNED: Of the 110 rodenticidal hepatotoxicity patients, 32 children (females: 56%; age: 16 [4.7-18] years; median, range) constituted the study patients. The study patients presented 4 (1-8) days after poison consumption (impulsive suicidal intent:31, accidental:1). Twenty children (62%) had ALI [MELD: 18 (8-36)] and 12 (38%) had ALF [MELD: 37 (24-45)].All children received standard medical care, including N-acetyl cysteine; ALF patients also received anti-cerebral edema measures. None of the patient families opted for liver transplantation. Seventeen children (ALI: 6, ALF: 11) were treated with PLEX-LV (3 [1-5] sessions, volume of plasma exchanged per session: 26 [13-38] ml/kg body weight) and peri-procedure low dose prednisolone.At 1 month, 28 of the 32 children (87.5%) were alive (4 ALF patients died). Of 10 children who met Kochi listing criteria for urgent liver transplantation, two children were ineligible for PLEX-LV (due to hemodynamic instability) and of the remaining 8 children treated by PLEX-LV, 6 (75%) survived.
UNASSIGNED: PLEX-LV shows promise as an effective non-liver transplant treatment in children with rodenticidal hepatotoxicity.
UNASSIGNED: We describe our experience with low-volume PLEX (PLEX-LV) in treating rodenticide ingestion induced hepatotoxicity in children.
UNASSIGNED: From prospectively collected database of rodenticidal hepatotoxicity patients managed as in-patient with department of Hepatology from December 2017 to August 2021, we retrospectively studied outcomes in children (≤18 years). Hepatotoxicity was categorized as acute liver injury (ALI, coagulopathy alone) or acute liver failure (ALF, coagulopathy and encephalopathy). Kochi criteria was used to assess need for urgent liver transplantation. The primary study outcome was one-month survival.
UNASSIGNED: Of the 110 rodenticidal hepatotoxicity patients, 32 children (females: 56%; age: 16 [4.7-18] years; median, range) constituted the study patients. The study patients presented 4 (1-8) days after poison consumption (impulsive suicidal intent:31, accidental:1). Twenty children (62%) had ALI [MELD: 18 (8-36)] and 12 (38%) had ALF [MELD: 37 (24-45)].All children received standard medical care, including N-acetyl cysteine; ALF patients also received anti-cerebral edema measures. None of the patient families opted for liver transplantation. Seventeen children (ALI: 6, ALF: 11) were treated with PLEX-LV (3 [1-5] sessions, volume of plasma exchanged per session: 26 [13-38] ml/kg body weight) and peri-procedure low dose prednisolone.At 1 month, 28 of the 32 children (87.5%) were alive (4 ALF patients died). Of 10 children who met Kochi listing criteria for urgent liver transplantation, two children were ineligible for PLEX-LV (due to hemodynamic instability) and of the remaining 8 children treated by PLEX-LV, 6 (75%) survived.
UNASSIGNED: PLEX-LV shows promise as an effective non-liver transplant treatment in children with rodenticidal hepatotoxicity.
摘要：
■在先前的报告中，没有符合Kochi标准(MELD评分≥36或基线INR≥6伴肝性脑病)(PMID:26310868)的杀虫性肝毒性患者接受紧急肝移植治疗后存活下来.血浆置换（PLEX）可以改善这些患者的生存率。
■我们描述了我们使用低容量PLEX（PLEX-LV）治疗儿童服用灭鼠剂引起的肝毒性的经验。
■从2017年12月至2021年8月在肝病科住院的杀虫性肝毒性患者的前瞻性数据库中，我们回顾性研究了儿童（≤18岁）的结局。肝毒性被归类为急性肝损伤(ALI，单独凝血病）或急性肝功能衰竭（ALF，凝血病和脑病）。Kochi标准用于评估紧急肝移植的需要。主要研究结果是一个月的生存。
■在110例杀虫肝毒性患者中，32名儿童（女性：56%；年龄：16[4.7-18]岁；中位数，范围)构成了研究患者。研究患者在服毒后4（1-8）天（冲动自杀意图：31，意外：1）。20名儿童（62％）患有ALI[MELD：18（8-36）]，12名（38％）患有ALF[MELD：37（24-45）]。所有儿童都接受了标准的医疗护理，包括N-乙酰半胱氨酸;ALF患者还接受了抗脑水肿措施。没有患者家属选择肝移植。17名儿童（ALI：6，ALF：11）接受了PLEX-LV治疗（3[1-5]次，每次会议交换的血浆体积：26[13-38]ml/kg体重）和围手术期低剂量泼尼松龙。在1个月，32名儿童中有28名(87.5%)存活(4名ALF患者死亡)。在符合紧急肝移植高知上市标准的10名儿童中，两名儿童不符合PLEX-LV治疗条件（由于血流动力学不稳定），其余8名儿童接受PLEX-LV治疗，6(75%)存活。
■PLEX-LV有望作为杀虫性肝毒性儿童的有效非肝移植治疗。
■我们描述了我们使用低容量PLEX（PLEX-LV）治疗儿童服用灭鼠剂引起的肝毒性的经验。
■从2017年12月至2021年8月在肝病科住院的杀虫性肝毒性患者的前瞻性数据库中，我们回顾性研究了儿童（≤18岁）的结局。肝毒性被归类为急性肝损伤(ALI，单独凝血病）或急性肝功能衰竭（ALF，凝血病和脑病）。Kochi标准用于评估紧急肝移植的需要。主要研究结果是一个月的生存。
■在110例杀虫肝毒性患者中，32名儿童（女性：56%；年龄：16[4.7-18]岁；中位数，范围)构成了研究患者。研究患者在服毒后4（1-8）天（冲动自杀意图：31，意外：1）。20名儿童（62％）患有ALI[MELD：18（8-36）]，12名（38％）患有ALF[MELD：37（24-45）]。所有儿童都接受了标准的医疗护理，包括N-乙酰半胱氨酸;ALF患者还接受了抗脑水肿措施。没有患者家属选择肝移植。17名儿童（ALI：6，ALF：11）接受了PLEX-LV治疗（3[1-5]次，每次会议交换的血浆体积：26[13-38]ml/kg体重）和围手术期低剂量泼尼松龙。在1个月，32名儿童中有28名(87.5%)存活(4名ALF患者死亡)。在符合紧急肝移植高知上市标准的10名儿童中，两名儿童不符合PLEX-LV治疗条件（由于血流动力学不稳定），其余8名儿童接受PLEX-LV治疗，6(75%)存活。
■PLEX-LV有望作为杀虫性肝毒性儿童的有效非肝移植治疗。
