Acute and Critical Care

Original Articles

Pediatrics
Acute severe hepatitis in children following extrahepatic infection in South Korea: etiology, clinical course, and outcomes: Sanghoon Lee, Young Ok Kim, Seo-Hee Kim; Acute Crit Care. 2025;40(1):122-127. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.000600

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Background
Acute hepatitis can occur in association with systemic diseases outside the liver. Acute severe hepatitis with markedly elevated transaminase levels following extrahepatic infection has been reported in children. However, research on this condition remains limited. This study aimed to investigate its etiology, clinical course, and outcomes.
Methods
We retrospectively reviewed data from 2013 to 2020 for children under 12 years old with elevated liver enzymes following systemic infection. Acute severe hepatitis was defined as serum transaminase levels exceeding 1,000 IU/L in the absence of underlying liver disease. We analyzed hepatitis-associated pathogens, liver enzyme trends, and factors influencing recovery.
Results
A total of 39 patients were included in this study. The most common age group was 7–12 months (54.8%), and 53.8% were male. Respiratory infections were the most common (61.5%), followed by gastrointestinal infections (23.1%), meningitis (10.3%), and urinary tract infections (5.1%). The median peak alanine transaminase (ALT) level was 1,515.8±424.2 IU/L, with a median time to peak ALT of 4.2±2.3 days from symptom onset. ALT levels normalized within 21 days in 71.8% of patients and within 28 days in 94.9%. Younger age was associated with delayed ALT normalization, whereas hepatoprotective agent use was associated with faster normalization.
Conclusions
Acute severe hepatitis can develop following respiratory and other systemic infections. Younger children were more susceptible and had a more prolonged disease course.

Citations

Citations to this article as recorded by

Differentiating leptospirosis from Rickettsial diseases and Q fever: A syndrome-based study in Southern Taiwan
Shih-Hao Lo, Chung-Hao Huang, Tun-Chieh Chen, Chun-Yu Lin, Po-Liang Lu, Ko Chang
Tropical Doctor.2026;[Epub] CrossRef

Trauma
Elixhauser comorbidity measures-based risk factors associated with 30-day mortality in elderly population after femur fracture surgery: a propensity scorematched retrospective case-control study: Dohyung Kim, Hyunmin Jo, Younsuk Lee, Kyoung Ok Kim; Acute Crit Care. 2020;35(1):10-15. Published online February 29, 2020; DOI: https://doi.org/10.4266/acc.2019.00745

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Abstract PDF

Background
As the average life expectancy increases, anesthesiologists confront unique challenges in the perioperative care of elderly patients who have significant comorbidities. In this study, we evaluated Elixhauser comorbidity measures-based risk factors associated with 30day mortality in patients aged 66 years and older who underwent femur fracture surgery. Methods: We used the Medical Information Mart for Intensive Care III which contains the medical records of patients admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center in the United States between 2001 and 2012 to identify patients admitted to the ICU after femur fracture surgery (n=209). Patients who died within 30 days of admission (case group, n=49) were propensity score-matched to patients who did not (control group, n=98). The variables for matching were age, sex, race, anemia (hemoglobin ≤10 g/dl), and malignancy. We attempted to explain mortality via nine independent factors: hypertension, uncomplicated diabetes, complicated diabetes, congestive heart failure (CHF), cardiac arrhythmias, chronic pulmonary disease, renal failure, neurological disorders other than paralysis, and peripheral vascular disease. Results: Logistic regression identified three significant risk factors: CHF, arrhythmias, and neurological disorders other than paralysis. The odds ratio (OR) for the 30-day mortality of CHF was 4.99 (95% confidence interval [CI], 2.18 to 12.06). The equivalent ORs for cardiac arrhythmias and neurological disorders other than paralysis were 2.61 (95% CI, 1.14 to 6.21) and 2.40 (95% CI, 0.95 to 6.48), respectively. Conclusions: Identifying patients with these risk factors (CHF, arrhythmias, and neurological disorders other than paralysis) will assist clinicians with perioperative planning and provide caregivers with valuable information for decision-making.

Citations

Citations to this article as recorded by

A machine learning-based prediction model for in-hospital mortality among critically ill patients with hip fracture: An internal and external validated study
Mingxing Lei, Zhencan Han, Shengjie Wang, Tao Han, Shenyun Fang, Feng Lin, Tianlong Huang
Injury.2023; 54(2): 636. CrossRef
Complications and hospitalization costs in patients with hypothyroidism following total hip arthroplasty
Yuanyuan Huang, Yuzhi Huang, Yuhang Chen, Qinfeng Yang, Binyan Yin
Journal of Orthopaedic Surgery and Research.2023;[Epub] CrossRef
How age and gender influence proximal humerus fracture management in patients older than fifty years
Akshar H. Patel, J. Heath Wilder, Sione A. Ofa, Olivia C. Lee, Michael C. Iloanya, Felix H. Savoie, William F. Sherman
JSES International.2022; 6(2): 253. CrossRef
Comorbidity indices in orthopaedic surgery: a narrative review focused on hip and knee arthroplasty
SaTia T. Sinclair, Ahmed K. Emara, Melissa N. Orr, Kara M. McConaghy, Alison K. Klika, Nicolas S. Piuzzi
EFORT Open Reviews.2021; 6(8): 629. CrossRef

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