Hepatic Encephalopathy in Children With Acute Liver Failure: Utility of Serum Neuromarkers.
Hepatic Encephalopathy in Children With Acute Liver Failure: Utility of Serum Neuromarkers.
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DOI：
10.1097/mpg.0000000000002351
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发表时间：
2019-07
影响因子：
2.9
通讯作者：
Nicole Toney;M. Bell;S. Belle;Regina M. Hardison;N. Rodriguez-Baez;K. Loomes;Y. Vodovotz;R. Zamora;Robert H. Squires
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文献类型：
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作者：
Nicole Toney;M. Bell;S. Belle;Regina M. Hardison;N. Rodriguez-Baez;K. Loomes;Y. Vodovotz;R. Zamora;Robert H. Squires
儿科急性肝衰竭（PALF）是一个公共卫生负担，通常需要长期住院和肝移植。肝性脑病（HE）是PALF的一种并发症，其预测结局的诊断工具有限。血清神经学标志物（神经元特异性烯醇化酶、S100β和髓鞘碱性蛋白）可在创伤性或缺血性脑损伤中升高。我们假设这些神经标记物与PALF中HE的发生有关。本分析的受试者为2012年5月至2014年12月期间由12家参与中心入组的PALF研究参与者。每日HE评估由研究者确定。分别采用酶联免疫吸附试验和MILLIPLEX技术测定神经和炎症标志物。为了模拟脑病，将这些标志物进行log 2转换，并使用具有logit链接和随机截距的广义线性混合模型单独检查与HE的相关性。结果：82名儿童有神经和炎症标记物水平和HE评估记录，大多数在患病期间进行了3天的评估。不确定的诊断（29%）是最常见的，中位年龄为2.9岁。观察到HE与S100β（比值比1.16，95%置信区间[1.03-1.29]，P = 0.04）和IL-6（比值比1.24 [1.11-1.38]，P = 0.006）显著相关。结论血清S100β和IL-6与PALF患儿HE的发生有关。测量这些标志物可能有助于评估PALF中的神经损伤，影响临床决策。
BACKGROUND Pediatric acute liver failure (PALF) is a public heath burden, often requiring prolonged hospitalization and liver transplantation. Hepatic encephalopathy (HE) is a complication of PALF with limited diagnostic tools to predict outcomes. Serum neurological markers (neuron-specific enolase, S100β, and myelin basic protein) can be elevated in traumatic or ischemic brain injury. We hypothesized that these neuromarkers would be associated with the development of HE in PALF. METHODS PALF study participants enrolled between May 2012 and December 2014 by 12 participating centers were the subjects of this analysis. Daily HE assessments were determined by study investigators. Neurological and inflammatory markers were measured using enzyme-linked immunosorbent assay and MILLIPLEX techniques, respectively. To model encephalopathy, these markers were log2 transformed and individually examined for association with HE using a generalized linear mixed model with a logit link and random intercept. RESULTS Eighty-two children had neurological and inflammatory marker levels and HE assessments recorded, with the majority having assessments for 3 days during their illness. An indeterminate diagnosis (29%) was most common and the median age was 2.9 years. Significant associations were observed for HE with S100β (odds ratio 1.16, 95% confidence interval [1.03-1.29], P = 0.04) and IL-6 (odds ratio 1.24 [1.11-1.38], P = 0.006). CONCLUSIONS Serum S100β and IL-6 are associated with HE in children with PALF. Measuring these markers may assist in assessing neurological injury in PALF, impacting clinical decisions.