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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 7
Jul.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(7): 1603-1608

Clinical features of children with hepatitis and granulocytopenia and risk factors for progression to aplastic anemia

DOI: 10.3969/j.issn.1001-5256.2021.07.025

  • Department of Liver Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China

Research funding:

Project on the Application of Clinical Characteristics in the Capital (Z181100001718030)

  • Received Date: 2020-11-18
  • Accepted Date: 2021-03-08
  • Published Date: 2021-07-20
    Abstract
  •   Objective  To investigate the incidence rate and clinical features of children with hepatitis and granulocytopenia and the risk factors for progression to aplastic anemia (AA).  Methods  A retrospective analysis was performed for 2944 children, aged ≤18 years, who were hospitalized due to abnormal liver function in Pediatric Liver Diseases Treatment and Research Center, The Fifth Medical Center of Chinese PLA General Hospital, from July 2014 to March 2020. Clinical features and prognosis were analyzed for children with new-onset neutropenia (< 1.5×109/L) during the course of the disease, and the risk factors for progression to AA were analyzed. The t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate risk factors.  Results  Among the 2944 children admitted due to abnormal liver function, 38 had hepatitis with granulocytopenia, with an incidence rate of 1.3%. Among these 38 children, 68.4% (26/38) had drug-induced liver injury, 2.6% (1/38) had autoimmune hepatitis, and 28.9% (11/38) had unexplained liver injury; as for blood abnormalities, 21.1% (8/38) had granulocytopenia, 47.4% (18/38) had granulocytopenia and reductions in three lines of blood cells, 7.9% (3/38) had agranulocytosis, and 23.7% (9/38) had agranulocytosis and reductions in three lines of blood cells. Bone marrow cytology showed that among the 38 children, 14 (36.8%) were diagnosed with hepatitis-associated AA (HAAA) and 24 (63.2%) were diagnosed with non-HAAA. In order to analyze the risk factors for HAAA, there were significant differences in CD4+ (8.5% vs 17%, P=0.008) and CD4+/CD8+ ratio (0.17 vs 0.47, P=0.015) between the HAAA group and the non-HAAA group. Further multivariate logistic regression analysis showed that the reduction in CD4+ was a risk factor for HAAA (β=-4.757, P < 0.05). All 38 children were given routine liver-protecting, transaminase-lowering, and jaundice clearance treatment. Among the 14 children with HAAA, 6 had gradual recovery of hemogram after immunosuppressant therapy, 7 had gradual recovery of hemogram after allogeneic hematopoietic stem cell transplantation, and 1 died due to severe AA; among the 24 children with non-HAAA, 23 had hemogram gradually returning to normal after treatment, and 1 died of acute liver failure.  Conclusion  AA should be taken seriously for children with hepatitis and granulocytopenia, especially for those with drug-induced or unexplained liver injury, and the reduction in CD4+ may be used as a predictive factor for AA.

     

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