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

Autor: Thanh NT; Children Hospital 2, Ho Chi Minh City, Viet Nam; Woolcock Institute of Medical Research, Viet Nam., Dat NT; University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam., Thinh TN; Children Hospital 2, Ho Chi Minh City, Viet Nam., Phuong NTM; Children Hospital 2, Ho Chi Minh City, Viet Nam; University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam. Electronic address: Ngocthinh0209@gmail.com., Thanh MTH; Children Hospital 2, Ho Chi Minh City, Viet Nam. Electronic address: thanhhonor@gmail.com., Bao NT; Children Hospital 2, Ho Chi Minh City, Viet Nam. Electronic address: tatdatnguyen1996@gmail.com., Son PT; Children Hospital 2, Ho Chi Minh City, Viet Nam. Electronic address: Thaison162@gmail.com., Viet DC; Children Hospital 2, Ho Chi Minh City, Viet Nam. Electronic address: dr.dochauviet@gmail.com., Tung TH; Children Hospital 2, Ho Chi Minh City, Viet Nam. Electronic address: trinhhuutung@gmail.com., Thien V; Shiga University of Medical Science, Otsu City, Shiga, Japan. Electronic address: thienvuyd01@gmail.com., Luan VT; Children Hospital 2, Ho Chi Minh City, Viet Nam. Electronic address: vothanhluan@gmail.com.
Jazyk: angličtina
Zdroj: Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis [Transfus Apher Sci] 2023 Apr; Vol. 62 (2), pp. 103617. Date of Electronic Publication: 2022 Nov 28.
DOI: 10.1016/j.transci.2022.103617
Abstrakt: 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.
Competing Interests: Conflicts of interest We declare that there is no conflict of interest.
(Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: