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Lee DU, Harmacinski A, Bahadur A, Lee KJ, Chou H, Shaik MR, Chou H, Fan GH, Kwon J, Ponder R, Chang K, Lee K, Lominadze Z. The cost implications of Wilson disease among hospitalized patients: analysis of USA hospitals. Eur J Gastroenterol Hepatol 2024; 36:929-940. [PMID: 38652529 PMCID: PMC11147697 DOI: 10.1097/meg.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIM In this study, we used a national cohort of patients with Wilson's disease (WD) to investigate the admissions, mortality rates, and costs over the captured period to assess specific subpopulations at higher burden. METHODS Patients with WD were selected using 2016-2019 National Inpatient Sample (NIS). The weighted estimates and patient data were stratified using demographics and medical characteristics. Regression curves were graphed to derive goodness-of-fit for each trend from which R2 and P values were calculated. RESULTS Annual total admissions per 100 000 hospitalizations due to WD were 1075, 1180, 1140, and 1330 ( R2 = 0.75; P = 0.13) from 2016 to 2019. Within the demographics, there was an increase in admissions among patients greater than 65 years of age ( R2 = 0.90; P = 0.05) and White patients ( R2 = 0.97; P = 0.02). Assessing WD-related mortality rates, there was an increase in the mortality rate among those in the first quartile of income ( R2 = 1.00; P < 0.001). The total cost for WD-related hospitalizations was $20.90, $27.23, $24.20, and $27.25 million US dollars for the years 2016, 2017, 2018, and 2019, respectively ( R2 = 0.47; P = 0.32). There was an increasing total cost trend for Asian or Pacific Islander patients ( R2 = 0.90; P = 0.05). Interestingly, patients with cirrhosis demonstrated a decreased trend in the total costs ( R2 = 0.97; P = 0.02). CONCLUSION Our study demonstrated that certain ethnicity groups, income classes and comorbidities had increased admissions or costs among patients admitted with WD.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Ashton Harmacinski
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Aneesh Bahadur
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Ki Jung Lee
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Hannah Chou
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Mohammed Rifat Shaik
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Harrison Chou
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Gregory Hongyuan Fan
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Jean Kwon
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Reid Ponder
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Kevin Chang
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - KeeSeok Lee
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA 02111, USA
| | - Zurabi Lominadze
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD 21201, USA
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Ferrarese A, Cazzagon N, Burra P. Liver transplantation for Wilson disease: Current knowledge and future perspectives. Liver Transpl 2024:01445473-990000000-00405. [PMID: 38899966 DOI: 10.1097/lvt.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Liver transplantation currently represents a therapeutic option for patients with Wilson disease presenting with end-stage liver disease or acute liver failure. Indeed, it has been associated with excellent postoperative survival curves in view of young age at transplant and absence of recurrence. Attention has shifted over the past decades to a wise expansion of indications for liver transplantation. Evidence has emerged supporting the transplantation of carefully selected patients with primarily neuropsychiatric symptoms and compensated cirrhosis. The rationale behind this approach is the potential for surgery to improve copper homeostasis and consequently ameliorate neuropsychiatric symptoms. However, several questions remain unanswered, such as how to establish thresholds for assessing pretransplant neuropsychiatric impairment, how to standardize preoperative neurological assessments, and how to define postoperative outcomes for patients meeting these specific criteria. Furthermore, a disease-specific approach will be proposed both for the liver transplant evaluation of candidates with Wilson disease and for patient care during the transplant waiting period, highlighting the peculiarities of this systemic disease.
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Affiliation(s)
- Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Nora Cazzagon
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Dang J, Chevalier K, Letavernier E, Tissandier C, Mouawad S, Debray D, Obadia M, Poujois A. Kidney involvement in Wilson's disease: a review of the literature. Clin Kidney J 2024; 17:sfae058. [PMID: 38660122 PMCID: PMC11040517 DOI: 10.1093/ckj/sfae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 04/26/2024] Open
Abstract
Wilson's disease (WD) is a rare inherited disease due to the mutation of the ATP7B gene, resulting in impaired hepatic copper excretion and its pathological accumulation in various organs such as the liver, the nervous system, or the kidneys. Whereas liver failure and neuropsychiatric disorders are the most common features, less is known about the renal complications. We conducted a review of the literature to define the characteristics and pathophysiology of kidney involvement during WD. This review shed light on strong evidence for direct copper toxicity to renal tubular cells. Excessive tubular copper accumulation might present with various degrees of tubular dysfunction, ranging from mild hydroelectrolytic and acid-base disorders to complete Fanconi syndrome. Proximal and distal renal tubular acidosis also favors development of nephrolithiasis, nephrocalcinosis, and bone metabolism abnormalities. Indirect complications might involve renal hypoperfusion as occurs in hepatorenal or cardiorenal syndrome, but also tubular casts' formation during acute hemolysis, rhabdomyolysis, or bile cast nephropathy. Acute kidney failure is not uncommon in severe WD patients, and independently increases mortality. Finally, specific and long-term therapy by D-penicillamin, one of the most efficient drugs in WD, can cause glomerular injuries, such as membranous nephropathy, minimal-change disease, and, rarely, severe glomerulonephritis. Altogether, our study supports the need for interdisciplinary evaluation of WD patients involving nephrologists, with regular monitoring of tubular and glomerular functions, to provide adequate prevention of renal and bone involvement.
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Affiliation(s)
- Julien Dang
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kevin Chevalier
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Emmanuel Letavernier
- AP-HP, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France
| | - Come Tissandier
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sarah Mouawad
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Dominique Debray
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Mickaël Obadia
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Aurélia Poujois
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
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Lafhal K, Sabir ES, Hakmaoui A, Hammoud M, Aimrane A, Najeh S, Assiri I, Berrachid A, Imad N, Boujemaa CA, Aziz F, El Hanafi FZ, Lalaoui A, Aamri H, Boyko I, Sánchez-Monteagudo A, Espinós C, Sab IA, Aboussair N, Bourrahouat A, Fdil N. Clinical, biochemical and molecular characterization of Wilson's disease in Moroccan patients. Mol Genet Metab Rep 2023; 36:100984. [PMID: 37323222 PMCID: PMC10267639 DOI: 10.1016/j.ymgmr.2023.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Background Wilson Disease (WD) is an autosomal recessive inherited metabolic disease caused by mutations in the ATP7B gene. WD is characterized by heterogeneous clinical presentations expressed by hepatic and neuropsychiatric phenotypes. The disease is difficult to diagnose, and misdiagnosed cases are commonly seen. Methods In this study, the presented symptoms of WD, the biochemical parameters as well as its natural history are described based on cases collected in Mohammed VI Hospital University of Marrakech (Morocco). We screened and sequenced 21 exons of ATP7B gene from 12 WD patients that confirmed through biochemical diagnosis. Results Mutational assessment of the ATP7B gene showed six homozygous mutations in 12 individuals however, 2 patients had no evidence of any mutation in promoter and exonic regions. All mutations are pathogenic and most were missense mutations. c.2507G > A (p.G836E), c.3694A > C (p.T1232P) and c.3310 T > C (p.C1104R) that were identified in 4 patients. The other mutations were a non-sense mutation (c.865C > T (p.C1104R)) detected in 2 patients, a splice mutation (c.51 + 4A > T) detected in 2 patients and a frameshift mutation (c.1746 dup (p.E583Rfs*25) detected in 2 patients. Conclusion Our study is the first molecular analysis in Moroccan patients with Wilson's disease, the ATP7B mutational spectrum in the Moroccan population is diverse and still unexplored.
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Affiliation(s)
- Karima Lafhal
- Metabolic Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
| | - Es-said Sabir
- Metabolic Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
| | - Abdelmalek Hakmaoui
- Center of Clinical Research, University Hospital Mohammed VI, Marrakech, Morocco
| | - Miloud Hammoud
- Metabolic Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
| | - Abdelmohcine Aimrane
- Metabolic Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
| | - Samira Najeh
- Metabolic Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
| | - Imane Assiri
- Metabolic Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
| | - Abdelaati Berrachid
- Metabolic Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
| | - Najwa Imad
- Mother-Child Hospital, Pediatric Department, Mohammed VI University Hospital, Cadi Ayad University, Marrakesh, Morocco
| | - Chaima Ait Boujemaa
- Center of Clinical Research, University Hospital Mohammed VI, Marrakech, Morocco
| | - Faissal Aziz
- National Center for Study and Research on Water and Energy, PO Box 511, Cadi Ayyad University, Marrakech., Morocco
| | - Fatima Zahra El Hanafi
- Mother-Child Hospital, Pediatric Department, Mohammed VI University Hospital, Cadi Ayad University, Marrakesh, Morocco
| | - Abdessamad Lalaoui
- Mother-Child Hospital, Pediatric Department, Mohammed VI University Hospital, Cadi Ayad University, Marrakesh, Morocco
| | - Hasna Aamri
- Mother-Child Hospital, Pediatric Department, Mohammed VI University Hospital, Cadi Ayad University, Marrakesh, Morocco
| | - Iryna Boyko
- Laboratory of Rare Neurodegenerative Diseases, Príncipe Felipe Research Center (CIPF), Valencia, Spain
| | - Ana Sánchez-Monteagudo
- Laboratory of Rare Neurodegenerative Diseases, Príncipe Felipe Research Center (CIPF), Valencia, Spain
- Joint Unit INCLIVA & IIS La Fe Rare Diseases, Valencia, Spain
| | - Carmen Espinós
- Laboratory of Rare Neurodegenerative Diseases, Príncipe Felipe Research Center (CIPF), Valencia, Spain
- Joint Unit INCLIVA & IIS La Fe Rare Diseases, Valencia, Spain
- Biotechnology Department, Faculty of Veterinary and Experimental Sciences, Catholic University of Valencia, Valencia, Spain
| | - Imane Ait Sab
- Mother-Child Hospital, Pediatric Department, Mohammed VI University Hospital, Cadi Ayad University, Marrakesh, Morocco
| | - Nisrine Aboussair
- Department of Medical Genetics, Mohammed VI University Hospital, Cadi Ayad University, Marrakesh, Morocco
| | - Aicha Bourrahouat
- Mother-Child Hospital, Pediatric Department, Mohammed VI University Hospital, Cadi Ayad University, Marrakesh, Morocco
| | - Naima Fdil
- Metabolic Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
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Patel AH, Ghattu M, Mazzaferro N, Chen A, Catalano K, Minacapelli CD, Rustgi V. Demographics and Outcomes Related to Wilson's Disease Patients: A Nationwide Inpatient Cohort Study. Cureus 2023; 15:e44714. [PMID: 37809179 PMCID: PMC10552679 DOI: 10.7759/cureus.44714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Background and objective Wilson's disease (WD) is a rare autosomal recessive disease caused by mutations in the ATP7B gene, leading to impairment in copper excretion and subsequent accumulation primarily in the liver and brain. There is scarce data in the literature on the outcomes and cost burden of WD. In light of this, we aimed to assess outcomes, mortality rates, and costs associated with WD patients and their management in the United States (US). Methods We conducted a retrospective cohort study based on data in the National Inpatient Sample (NIS) database from 2007 to 2017. A total of 17,713 patients with a diagnosis of WD were identified using the International Classification of Diseases, Ninth or Tenth Revision (ICD-9/10) codes. Bivariate analyses were performed using t-tests for continuous variables and Pearson's chi-square tests for categorical variables, where two-sided p-values <0.05 were considered statistically significant. Results The majority of the 17,713 identified patients were female. The mean age of the WD cohort was 49 years. WD patients had a higher prevalence of Kayser-Fleischer rings, neuropsychiatric symptoms, and liver-related complications including acute hepatitis, liver failure, portal hypertension, and cirrhosis. Peptic ulcer disease, connective tissue disease, and hemolytic anemia were significantly more common in the WD cohort. Compared to the non-WD cohort, the WD cohort had a significantly higher mortality rate, longer length of stay (LOS), and increased hospitalization costs (p<0.0001). A higher proportion of patients who had undergone orthotopic liver transplantation (OLTx) were in the 18-34 and 35-44-year-old subgroups. On the contrary, the highest proportion of patients with WD who had not undergone OLTx were in the 55-89-year-old subgroup. WD patients who had undergone OLTx had a lower degree of comorbidities, decreased mortality rate, and shorter LOS (all p<0.0001) compared to WD patients who had not undergone OLTx. Conclusion Based on our findings, patients with WD had a higher LOS, mean hospitalization costs, and mortality rate compared to the non-WD cohort. Mortality rate and LOS were significantly lower in WD patients who had undergone OLTx.
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Affiliation(s)
- Ankoor H Patel
- Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Meghana Ghattu
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical school, New Brunswick, USA
| | - Natale Mazzaferro
- Biostatistics and Epidemiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Alexander Chen
- Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Kaitlyn Catalano
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Carlos D Minacapelli
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Vinod Rustgi
- Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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Członkowska A, Niewada M, Litwin T, Kraiński Ł, Skowrońska M, Piechal A, Antos A, Misztal M, Khanna I, Kurkowska-Jastrzębska I. Seven decades of clinical experience with Wilson's disease: Report from the national reference centre in Poland. Eur J Neurol 2022. [PMID: 36427277 DOI: 10.1111/ene.15646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Wilson's disease (WD) is a rare autosomal recessive disorder causing excessive copper deposition and a spectrum of manifestations, particularly neurological and hepatic symptoms. We analysed the clinical characteristics of patients with WD admitted to the country's only reference centre, which provided long-term care to most adult patients in Poland over seven decades (pre-1959 to 2019). METHODS Electronic prospective data collection began in the 2000s and, for prior years, medical records were analysed retrospectively. Demographic and clinical characteristics, treatment and outcomes were analysed by decade of diagnosis. Life-years lost were estimated in patients with WD compared with the general population. Kaplan-Meier curves were used for a time-to-death analysis using 2000-2009 as a reference. RESULTS In total, 929 patients were analysed. The number of patients increased from 21 before 1959 to 315 for 2000 to 2009 period. Mostly males were diagnosed before the 1990s, but the numbers of female patients diagnosed increased thereafter. Initially, most patients presented with neurological manifestations; however, the incidence of hepatic manifestations and asymptomatic presentations increased over time as patients were diagnosed early and consequently were more independent at diagnosis. Fewer Kayser-Fleischer rings were detected recently. Prior to 1970, patients were treated with D-penicillamine (DP); however, since the introduction of zinc, both therapies have been used as often. Since the 1990s, switches between DP and zinc were recorded in 6%-7% of patients. Consistent improvement in survival has been observed over the years. CONCLUSIONS This is the largest cohort of patients with WD reported in Poland, with the longest follow-up. Earlier diagnosis and prognosis have improved over seven decades.
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Affiliation(s)
- Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Łukasz Kraiński
- Decision Analysis and Support Unit, Warsaw School of Economics, Warsaw, Poland
| | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Agnieszka Piechal
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Monika Misztal
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Ishani Khanna
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Mahmud S, Gulshan J, Baidya M, Rashid R, Tasneem F, Hasan AR, Farhana T, Ahmed SS. Outcome of Wilson’s disease in Bangladeshi children: a tertiary center experience. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Wilson disease (WD) is an inherited disorder of copper metabolism commonly involving the liver, cornea, and brain. Its incidence is increasing day by day worldwide. Early diagnosis and prompt treatment are the key for best outcome.
Material and methods
A cross-sectional descriptive study was done from January 2014 to December 2019. Sixty children of both genders between 3 and 18 years were diagnosed by clinical and laboratory profile meeting selected criteria.
Results
Mean age was 8.42 ± 2.6 years and male female ratio was 1.5:1. Consanguinity of marriage was found in 38.3% cases. Seventy percent of cases were hepatic, 16.7% were neuropsychiatric, 5.0% were hepatic with neuropsychiatric, and 8.3% cases were manifested asymptomatically. Asymptomatic and hepatic WD were reported between 3 and 10 years and most of the neuropsychiatric and hepatic with neuropsychiatric manifested after 10 years of age. More than 50% cases improved, a little more than 20% children died, 18.4% were unchanged and 6.6% were hepatic added neuropsychiatric manifestations. Most of the asymptomatic (100%) and hepatic (61.9%) cases improved. High mortality was found with 76.9% cases of acute liver failure (ALF), 7.7% case of chronic liver disease (CLD) and 25% cases of CLD with portal hypertension (CLD and PH). Most of the neuropsychiatric cases (90.0%), and approximately two-third (66.6%) of hepatic with neuropsychiatric cases remained unchanged. Neuropsychiatric manifestations were added in 15.4% cases of CLD and 25% cases of CLD with PH patient. The treatment was well tolerated in 66% children without any side effects. Low WBC (6.3%) and platelet count (4.3%), vomiting (6.3%), anorexia (4.3%), loss of taste (4.3%), rash (4.3%), and proteinuria (2.1%) were found in few cases.
Conclusion
Majority of the children were presented with hepatic manifestations. More than half of patients with WD treated by D-penicillamine (DP) were improved. Significant mortality was found in acute liver failure whereas neuropsychiatric presentations had persistent abnormalities. No major side effects of DP was observed in most of the cases. Early diagnosis and prompt treatment were crucial for better outcome.
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