Abstract: Objective To analyze the clinical characteristics and laboratory findings of children with influenza-associated encephalopathy and acute liver failure, with the aim of improving understanding and management of this condition. Methods Data from six inpatients with influenza-assoicated encephalopathy and acute liver failure, treated at Guangzhou Women and Children's Medical Center between June 2022 to May 2023. were collected and statistically analyzed for their clinical characteristics and laboratory findings. Results The onset of the disease primarily occured in the spring and early summer, affecting children aged 1 year 2 months to 7 years, with 4 males and 2 females. All patients presented with fever, with some also experiencing cough, runny nose, and vomiting. Lung involvement was mild, but the condition progressed rapidly. Neurological symptoms, notably generalized Tonic-Clonic Seizures, emerged within 24 hours, followed swiftly by altered consciousness. Cerebrospinal fluid analysis showed normal white blood cells and glucose levels, with elevated trace proteins. CT/MRI findings revealed symmetrical damage to areas such as the periventricular region, pons, bilateral thalamus, cerebellum, and white matter. Severe liver function impairment developed within 48 hours and peaked by day 3, With mean ALT and AST levels reaching 2629.33 U/L and 7054 U/L, respectively. A marked elevation in LDH was noted, with an average of 5810.33 U/L, while γ- GT, TBil and TBA remained relatively normal, Blood glucose and ammonia levels were mostly normal, but coagulation function was significantly impared. All patients required tracheal intubation and mechanical ventilation, and were treated with immunoglobulin and glucocorticoids. Two patients underwent plasma exchange and continuous renal replacement therapy. Three patients (50%) ultimately died. Conclusion Children with influenza-associated encephalopathy and acute liver failure primarily present with recurrent fever, seizures, altered consciousness, significantly elevated liver enzymes, relatively normal bile enzyme levels, and marked abnormalities in blood coagulation. The condition has an acute onset, progresses rapidly, and is associated with high mortality and poor prognosis, warranting close attention.

Key words: Influenza, Children, Encephalopathy, Liver failure