2559

PROGNOSIS FACTORS OF PERSISTENT HEPATIC DAMAGE IN CHILDREN YOUNGER THAN 5 YEARS WITH ACETMINOPHEN POISONING

Escalante GP¹, Montoya CMA¹, Talavera PJO²

¹ Hospital de Pediatria. Centro Medico Nacional Siglo XXI. Instituto Mexicano del Seguro Social. Mexico DF. Mexico city

² Unidad de Investigacion de Epidemiologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Socia. Mexico, D.F. Mexico city

Objective: To know the prognosis factors in the development of persistent hepatic damage (PHD) for more than 72 hours in children younger than 5 years with acetaminophen (ACM) poisoning and antidotal treatment with N-acetylcysteine (NAC).

Methods: prospective cohort study. We studied 108 patients, were made concentrations trials for acetaminophen, prothrombin time and hepatic function tests at 24,48 and 72 hours with clinical evaluation, when ACM levels were above of the therapeutic levels(20 μg/dl), treatment with NAC was given, also were made serological tests for hepatitis A, B, C and a questionary for the variables in study.

Results: Were excluded 9 patients. Of the 99 remainder, 20 had PHD caused by acetaminophen. The mean age in months was 20+/-6, In the bivariate analysis than had a relative risk>2 and the confidence interval 95% were the use with drugs inductive of the microsomal hepatic system (IMHS), clinical phase (CP) of toxicity II, III and the levels of ACM. In the multiple logistic regression the significance of age was from 3 to 12 months and the use of IMHS. In the analysis of connected consolidation of age with the use of IMHS, alpha 47

Children, 8.5% of probability of PHD in children >12 months of age; beta: 40 children from 3 to 12 months of age without IMHS, 25% of PHD; and gamma 12 patients with IMHS, probability 50% for PHD. In the CP, stratum A age >12 months without IMHS, CPI, PHD 3.3%, B in CP I or II with age < or >12 months, PHD 20% and C any age with IMHS or in CP III 57% of PHD.

Conclusion: A prognostic index was obtained, according to the 3 significant variables that you can apply without necessity of ACM levels. This confirms that in children < 12 months of age, exposed to multiple doses of ACM have a bad prognostis for PHD.