In the present study, 50 children with hepatic cirrhosis and 50 healthy children were studied in the control group.
The mean and standard deviation of the age of children with hepatic cirrhosis and healthy children were 65.4 ± 83.0 and 48.3 ± 69.2 months, respectively, which were not statistically significant. Also, 24 children with hepatic cirrhosis and 18 healthy children were boys. The mean and standard deviation of the PELD score among children with hepatic cirrhosis was 17.6 ± 3.8. The lowest and highest PELD scores were 12 and 27, respectively. The results of the study showed that the most common etiology of hepatic cirrhosis in the studied children was genetic-metabolic diseases (13 patients, 26%), Wilson disease (11 patients, 22%), and autoimmune hepatitis (10 patients, 20%). Also, 7 patients (14%) were diagnosed with cryptogenic cirrhosis, 6 patients (12%) with biliary atresia, and pancreatic cancer with liver metastases in 3 patients (6%). Additionally this study investigated that the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK P), total bilirubin, direct bilirubin, albumin, total protein, prothrombin time(PT), and partial thromboplastin time(PTT) were significantly different between cirrhotic and healthy children (Table 1).
Out of a total of 50 children with hepatic cirrhosis, 21 children (42%) had abnormal findings in EEG, while none of the children in the healthy group had abnormal findings in EEG. Irregular spikes along with alpha waves were the most common EEG findings reported in 8 patients (16%). After that, fast waves (4 patients, 8%), slow and high voltage (4 patients, 8%), and slow with frequent epileptic discharge (2 patients, 4%) were the most frequent among the EEG findings in the studied patients. Also, irregular spikes along with delta and triphasic waves were observed in 4% and 2% of children with hepatic cirrhosis, respectively.
Patients with abnormal EEG patterns had a significantly higher average age (62.1 ± 117.19 months) than patients with normal EEG (56.9 ± 58.3) (P = 0.001). We also observed that among the children with abnormal EEG findings, 16 (76.1%) were older than 7 years and only 5 (23.8%) were younger than 7 years. Abnormal EEG findings had no statistically significant association with patient gender (P = 0.578). Children with cirrhosis with abnormal EEG findings had a higher mean PELD score (18.1 ± 4.1) than patients with normal EEG findings (17.2 ± 3.7). The results also showed that 70% (7 patients) of patients with PELD score ≥ 20 had abnormal EEG findings, but these findings were not statistically significant (P = 0.073). The sensitivity of EEG for predicting the severity of cirrhosis was estimated to be 70% and the specificity to be 65%.
A significant percentage of patients with abnormal EEG findings had abnormal serum levels of AST (13 patients, 61.9%) and ALT (47.6%). The mean serum levels of AST and ALT in patients with abnormal EEG findings (140.3 ± 256.5 and 135.3 ± 190.5) were significantly higher than in patients with normal EEG findings (135.4 ± 215.1 and 130.5 ± 157.3) (P = 0.010 and P = 0.030). Also, the results indicated that there is a statistically significant relationship between abnormal EEG findings and serum levels of ALK P (P = 0.464), Bili T (P = 0.774), D (P = 0.774), and Alb (P = 0.686). T.Pro (P = 0.549), PT (P = 0.171), and PTT (0.243) did not exist (Table 2).
By examining the etiology of hepatic cirrhosis in the studied patients, it was found that among the patients with abnormal EEG findings, 8 patients (38%) were suffering from Autoimmune Hepatitis. 80% of patients with autoimmune hepatitis had abnormal findings in EEG(P = 0.011). No significant statistical association was observed between other types of cirrhosis etiology and abnormal EEG findings (Table 3).
Table 1
Baseline and Demographic Characteristics of Children with Cirrhosis and Their Controls
Parameters | Cirrhotic Children (N = 50) | Healthy Children (N = 50) | P Value |
Mean (SD) | Minimum - Maximum | Mean (SD) | Minimum - Maximum |
Age (mon) | 83.0(65.4) | 2-204 | 69.2(48.3) | 2-156 | 0.233 |
PELD score | 17.6(3.8) | 12–27 | | | |
Aspartate amino transferase (IU/L) | 232.5(121.8) | 38–419 | 32.5(9.6) | 20–45 | 0.001 |
Alanine aminotransferase (IU/L) | 171.3(116) | 42–366 | 23.6(7.5) | 12–38 | < 0.001 |
Alkaline phosphatase (IU/L) | 877.6(619.5) | 141–2060 | 389(123.8) | 211–575 | < 0.001 |
Total bilirubin (mg/dL) | 16.2(14.3) | 1.5–39 | 0.9 (0.4) | 0.5–2 | < 0.001 |
Direct bilirubin (mg/dL) | 5.7(5.7) | 0.7–15 | 0.29 (0.25) | 0.1–1 | < 0.001 |
Albumin (g/dL) | 2.8(0.6) | 1.7–3.8 | 4.4 (0.5) | 3.2–5 | 0.027 |
Total protein (g/dL) | 5.0(0.8) | 4-6.3 | 7 (0.8) | 5.8–8.2 | 0.006 |
Prothrombin time (s) | 27.6(9.3) | 15–41 | 12.6 (1.07) | 10–14 | 0.04 |
Partial thromboplastin time (s) | 49.8(12.1) | 28–66 | 33.7 (4.9) | 30–45 | 0.01 |
Table 2
A Comparison of Different Clinical and Laboratory Parameters Between Cirrhotic Children with Normal and Abnormal EEG Profiles
Parameters | Electroencephalography | P value |
Normal(N = 29) | Abnormal(N = 21) |
Age (years) | 7 > | 21 | 5(23.8%) | 0.001 |
7 ≤ | 8 | 16(76.1%) |
Sex | Male | 15(51.7%) | 9(42.8%) | 0.578 |
Female | 14(48.2%) | 12(57.1%) |
PELD score | 20 > | 26(89.6%) | 14(66.6%) | 0.073 |
20 ≤ | 3(10.3%) | 7(33.3%) |
Aspartate amino transferase (IU/L) | Normal | 22(75.8%) | 8(38.09%) | 0.010 |
Abnormal | 7(24.1%) | 13(61.9%) |
Alanine aminotransferase (IU/L) | Normal | 24(82.7%)T | 11(52.3%) | 0.030 |
Abnormal | 5(17.2%) | 10(47.6%) |
Alkaline phosphatase (IU/L) | Normal | 25(86.2%) | 16(76.1%) | 0.464 |
Abnormal | 4(13.7%) | 5(23.8%) |
Albumin (g/dL) | Normal | 16(55.1%) | 14(66.6%) | 0.686 |
Abnormal | 13(44.8%) | 7(33.3%) |
Total protein (g/dL) | Normal | 24(82.7%) | 18(85.7%) | 0.549 |
Abnormal | 5(17.2%) | 3(14.2%) |
Total bilirubin (mg/dL) | Normal | 18(62.06%) | 14(66.6%) | 0.774 |
Abnormal | 11(37.9%) | 7(33.3%) |
Direct bilirubin (mg/dL) | Normal | 18(62.06%) | 14(66.6%) | 0.774 |
Abnormal | 11(37.9%) | 7(33.3%) |
Prothrombin time (s) | Normal | 24(82.7%) | 17(80.9%) | 0.117 |
Abnormal | 5(17.2%) | 4(19.04%) |
Partial thromboplastin time (s) | Normal | 27 (93.1%) | 18(85.7%) | 0.243 |
Abnormal | 2(6.8%) | 3(14.2%) |
Table 3
A Comparison of Different Etiology of Cirrhosis Between Cirrhotic Children with Normal and Abnormal EEG Profiles
Etiology of Cirrhosis | Electroencephalography | P value |
Normal(N = 29) | Abnormal(N = 21) |
Genetic-Metabolic diseases | YES | 11(37.9%) | 2(9.5%) | 0.095 |
NO | 18(62.06%) | 19(90.4%) |
Wilson | YES | 5(17.2%) | 6(28.5%) | 0.491 |
NO | 24(82.7%) | 15(71.4%) |
Autoimmune Hepatitis | YES | 2(6.8%) | 8(38.09%) | 0.011 |
NO | 27(93.1%) | 13(61.9%) |
Cryptogenic cirrhosis | YES | 5(17.2%) | 2(9.5%) | 0.684 |
NO | 24(82.7%) | 19(90.4%) |
Biliary atresia | YES | 5(17.2%) | 1(4.7%) | 0.380 |
NO | 24(82.7%) | 20(95.2%) |
Pancreatic cancer with metastasis to the liver | YES | 1(3.4%) | 2(9.5%) | 0.565 |
NO | 28(96.5%) | 19(90.4%) |