Abstract
Fulminant hepatic failure (FHF) is potentially fatal disease. Fulminant hepatic failure was defined as hepatic based coagulopathy (PT>20 sec or INR >2) with or without hepatic encephalopathy within 8 weeks of the onset of symptoms. The etiology of FHF in children differs around the world. In the developing world and in certain communities in developed countries hepatitis A is the most important etiologic agent causing FHF in children. Hepatitis B virus infection is the most important cause of FHF in endemic areas. The objective of study was etiology, outcome and risk factors for FHF in children at tertiary care hospital Sukkur Pakistan. This retrospective review of patients 1-14 years admitted with FHF from July 2007 to June 2012, at paediatric department of Ghulam Muhammad Mahar Medical College Hospital Sukkur. Eighty patients with FHF (50 males and 30 females) were admitted. The mean age was 6.5 years majority were in age group of 5-9 years. The most common etiologic cause of FHF was found viral hepatitis in 62 (77.5%) of cases, followed by autoimmune hepatitis in 3 (3.75%), while in 11 (13.75%) of children etiology was not established. Among viral hepatitis 62 (77.5%) cases, HAV was found in 50 (80.65%) and HBV in11 (17.75%). All patients had encephalopathy, grade 3 was most common in 30 (37.50%), followed by grade 2 (31.25%) and grade 4 (20%) respectively. All patients with grade 4 and 83.34% of grade 3 encephalopathy expired. Forty five (56.25%) patients were expired and 35 (43.75%) were recovered. Patients with bilirubin 13.0-8.0 mg/dl vs 6.7-3.3 mg/dl recovered. ALT was lower in expired patients 467-382 IU/L vs 1834.3-1550.2 IU/Lin recovered children. Majority of children 45 out of (52) expired with INR value of 4 or more. The risk factors in our study of FHF patients were grade 3 or 4 encephalopathy, high bilirubin, low ALT and INR >4. We conclude viruses are one of the important etiologic agents of FHF in children. Children with FHF with high grade encephalopathy (3 or 4), high bilirubin, low ALT and INR >4 had poor outcome and high mortality without liver transplant.

Key words: Fulminant hepatic failure, Etiology-viruses, poor outcome, risk factors and children