Evaluation of a Scoring System for Assessing Prognosis in Pediatric Acute Liver Failure

Lu, Brandy; Gralla, Jane; Liu, Edwin; Dobyns, Emily L.; Narkewicz, Michael R.; Sokol, Ronald J.

doi:10.1016/j.cgh.2008.05.013

Cited by 51 publications

(61 citation statements)

References 28 publications

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“…Distilling multiple clinical and biochemical measures into a practical model that can be used at the bedside for each decision interval remains a challenge. Previous predictive models for ALF in adults and children have included clinical and biochemical measures that are objective (e.g, INR, bilirubin, ammonia, age) or subjective (e.g., jaundice, encephalopathy) at the time of admission to hospital, the highest recorded or “peak” value(13, 14), or combinations of these data elements(2, 15–17). Measures obtained only at admission are limited by their inability to account for disease progression or improvement during the ensuing days.…”

Section: Discussionmentioning

confidence: 99%

Clinical Course among Cases of Acute Liver Failure of Indeterminate Diagnosis

Belle

Horslen

et al. 2016

The Journal of Pediatrics

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Objective To investigate the heterogeneity in clinical course among those with pediatric acute liver failure (PALF) of indeterminate disease etiology. Study design We studied participants enrolled in the PALF registry study with “indeterminate disease” (IND) final diagnosis. Growth mixture modeling (GMM) was used to analyze participants’ INR, total bilirubin and clinical encephalopathy (HE) trajectories in the first 7 days following enrollment. Participants with at least 3 values for one or more of the measurements were included. We examined the association between the resulting latent subgroup classification with participants’ characteristics and disease outcomes. Data from PALF participants with specified etiologies (non-IND) were utilized to investigate the potential diagnostic value of the latent subgroups. Results In this sample of 380 IND participants, 115 (30%) experienced mild and quickly improving disease trajectories and another 48 (13%) started with severe disease, but improved by day 7. The majority of participants (216, 57%) had disease trajectories that worsened over time. The identified patterns of disease trajectories are predictive of outcome (p<.001). The trajectory patterns are associated with the underlying disease etiology (p<.001) for the 488 non-IND participants. Conclusions The clinical courses of indeterminate PALF participants exhibit distinct trajectory patterns which have important prognostic and potentially diagnostic value.

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Section: Discussionmentioning

confidence: 99%

Clinical Course among Cases of Acute Liver Failure of Indeterminate Diagnosis

Belle

Horslen

et al. 2016

The Journal of Pediatrics

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“…The Pediatric Risk of Mortality score was applied to assess general morbidity and the associated mortality risk. The model endstage liver disease and pediatric end-stage liver disease scores and the pediatric ALF (PALF) liver injury unit score (14) were used to assess the severity of ALF and the need for transplantation, respectively (Table 2). Eight patients were registered for LTX, and SPAD was simultaneously initiated as rescue treatment for progressive disease and bridging to transplantation, which was performed within 14 -60 hrs after registration.…”

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confidence: 99%

Continuous veno-venous single-pass albumin hemodiafiltration in children with acute liver failure*

Ringe

Varnholt²,

Zimmering³

et al. 2011

Pediatric Critical Care Medicine

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In childhood acute liver failure, treatment with single-pass albumin dialysis was generally well tolerated and seems to be effective in detoxification and in improving blood pressure, thus stabilizing the critical condition of children before liver transplantation and facilitating bridging to liver transplantation. It may be beneficial in avoiding severe neurologic sequelae after acute liver failure and thereby improve survival. Single-pass albumin dialysis is an inexpensive albumin-based detoxification system that is easy to set up and requires little training. Whether and to what extent single-pass albumin dialysis can support children with acute liver failure until native liver recovery remains unclear.

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“…A recent study evaluating a pediatric Liver Injury Unit score based upon total bilirubin, INR, and ammonia at presentation and with "peak" values, appears to effectively predict survival without liver transplant; further prospective analyses will be necessary to confirm these findings [48].…”

Section: Prognosismentioning

confidence: 83%

Intensive Care Management of Children with Acute Liver Failure

Bhatia

Lodha

2010

Indian J Pediatr

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Acute liver failure is an uncommon condition associated with multi organ involvement, high morbidity and mortality. Etiology of acute liver failure varies with age and geographical location. Most cases of acute liver failure in India are due to infectious causes predominantly viral hepatitis. A significant group with indeterminate causation remains, despite careful investigation. The etiology of acute liver failure in infants is largely metabolic. The mainstay of management is supportive care in an intensive care unit. Monitoring of clinical and biochemical parameters is done frequently until the patient becomes stable. Mortality is predominantly due to raised intracranial pressure, infections and multi-organ failure. Liver transplant is an important life saving procedure for children with acute liver failure.

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Evaluation of a Scoring System for Assessing Prognosis in Pediatric Acute Liver Failure

Cited by 51 publications

References 28 publications

Clinical Course among Cases of Acute Liver Failure of Indeterminate Diagnosis

Clinical Course among Cases of Acute Liver Failure of Indeterminate Diagnosis

Continuous veno-venous single-pass albumin hemodiafiltration in children with acute liver failure*

Intensive Care Management of Children with Acute Liver Failure

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