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Serum phosphate level as a predictor of outcome in children with acute liver failure

Gastroenterology & Hepatology: Open Access
Rafia Rashid, Bazlul Karim ASM, Rukunuzzaman, Wahiduzzaman Mazumder, Fahmida Islam, Ruhina Tasmeen


Objectives:Clinical and laboratory predictors of recovery in children with acute liver failure (ALF) are limited. Recent studies reported hypophosphatemia as a laboratory indicator of recovering liver function. Hence, this study aimed to record serum phosphate levels and to identify its predictive relationship with clinical outcome.

Methods:This cross-sectional descriptive study was conducted at the Department of Paediatric Gastroenterology & Nutrition, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from 2017 to 2019. Twenty-one patients were selectedpurposively. Parents gave informed consent during recruitment. Demographic data, vaccination history, and other information regarding etiology and complications were recorded. Serum bilirubin, albumin, creatinine, electrolytes, prothrombine time, were carried out as required during the hospital stay. Serum phosphate levels were measured at admission and two days apart whenever possible. Fisher's exact test determined the association between hypophosphatemia and clinical outcome. Logistic regression was performed to analyze the predictive relationship between serum phosphate level and recovery.

Results:More than half (52.4%) of the studied patients died. Among the studied patients, Hepatitis A virus infection was the most frequent cause. Clinical outcome was significantly associated with hypophosphatemia (p = 0.009). Hypophosphatemia was usually found in patients who died. Logistic regression showed significant (p = 0.017) predictive relationship between serum phosphate level and recovery. This result indicates that with one mg/dL increase in serum phosphate level, the odds of recovering are higher by a factor of 3.605.

Conclusions: This study concludes that serum phosphate levels may be a good predictor of clinical outcome in children with ALF.


paediatric hepatology, liver function test, hypophosphatemia, serum bilirubin, albumin, creatinine, electrolytes,