Analysis of viral testing in nonacetaminophen pediatric acute liver failure

Pediatric Acute Liver Failure Study Group

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Objective: Viral infections are often suspected to cause pediatric acute liver failure (PALF), but large-scale studies have not been performed. We analyzed the results of viral testing among nonacetaminophen PALF study participants. Methods: Participants were enrolled in the PALF registry. Diagnostic evaluation and final diagnosis were determined by the site investigator and methods for viral testing by local standard of care. Viruses were classified as either causative viruses (CVs) or associated viruses (AVs). Supplemental testing for CV was performed if not done clinically and serum was available. Final diagnoses included ''viral,'' ''indeterminate,'' and ''other.'' Results: Of 860 participants, 820 had at least 1 test result for a CV or AV. A positive viral test was found in 166/820 (20.2%) participants and distributed among ''viral'' (66/80 [82.5%]), ''indeterminate'' (52/420 [12.4%]), and ''other'' (48/320 [15.0%]) diagnoses. CVs accounted for 81/166 (48.8%) positive tests. Herpes simplex virus (HSV) was positive in 39/335 (11.6%) who were tested 26/103 (25.2%) and 13/232 (5.6%) among infants 0 to 6 and >6 months, respectively. HSV was not tested in 61.0% and 53% of the overall cohort and those 0 to 6 months, respectively. Supplemental testing yielded 17 positive, including 5 HSV. Conclusions: Viral testing in PALF occurs frequently but is often incomplete. The evidence for acute viral infection was found in 20.2% of those tested for viruses. HSV is an important viral cause for PALF in all age groups. The etiopathogenic role of CV and AV in PALF requires further investigation.

Original languageEnglish (US)
Pages (from-to)616-623
Number of pages8
JournalJournal of pediatric gastroenterology and nutrition
Volume59
Issue number5
DOIs
StatePublished - Nov 8 2014

Keywords

  • Cytomegalovirus
  • Epstein-barr virus
  • Hepatotropic viruses
  • Herpesvirus
  • Human herpesvirus-6

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

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