Multiple organ involvement and ICU considerations for the care of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in children

Mataya, Leslie; Srinivasan, Vijay; Rand, Elizabeth B.; Alcamo, Alicia M.

doi:10.21037/tp-20-375

Cited by 7 publications

(5 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 6 The mortality rate of pediatric ACLF ranged between 20% and 30%. 7 Compared to CLD, the mortality of pediatric ACLF was 5 times higher. 7 Considering the general scarcity of organ donation, transplant lists lead to long waiting times between donors and recipients, and the management options are critical in terms of survival during this waiting period.…”

Section: Introductionmentioning

confidence: 97%

“… 7 Compared to CLD, the mortality of pediatric ACLF was 5 times higher. 7 Considering the general scarcity of organ donation, transplant lists lead to long waiting times between donors and recipients, and the management options are critical in terms of survival during this waiting period. The chart management for pALF and ACLF aims to stabilize vital organ functions, removes circulating cytokines and toxic metabolites, and provides deficient plasma factors.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Extracorporeal Therapies in Children with Acute Liver Failure: A Single-Center Experience

Gün¹,

Durak²,

Pervane³

et al. 2023

Turk J Gastroenterol

View full text Add to dashboard Cite

Background: The aim of this study is to determine the indication, timing, and administration of extracorporeal therapies such as total plasma exchange and continuous renal replacement therapy in children with acute liver failure or acute-on-chronic liver failure. Methods: This study is conducted as a retrospective, single-center study. Between January 2016 and December 2021, pediatric acute liver failure or acute-on-chronic liver failure patients for whom total plasma exchange and/or continuous renal replacement therapy was performed were included in this study. Results: Thirty-four children with acute liver failure or acute-on-chronic liver failure were included during the study period. The children comprised 14 (41.1%) males, and the median age of the patients was 54 months (5-21). Twenty-four patients (70.6%) had pediatric acute liver failure, and 10 patients (29.4%) had acute-on-chronic liver failure. Patients’ median model for end-stage liver disease and pediatric end-stage liver disease scores were 24.7/23.5, respectively. Total plasma exchange therapy was performed on all patients whereas continuous renal replacement therapy was performed on 13 patients (38.2%). The median duration of continuous renal replacement therapy was 2.5 days (2-24). The median number of the total plasma exchange sessions was 3 (1-20). The median length of stay in pediatric intensive care unit was 4.5 (2-74) days. Eleven (32.5%) patients had 1 or more improvements in hepatic encephalopathy scores after extracorporeal therapy. Eleven (32.5%) patients died. There was a significant difference between the survivors and non-survivors with respect to levels of albumin, ammonia, pediatric risk of mortality scores, and pre-hepatic encephalopathy scores. Liver transplantation was performed in 4 of 24 pediatric acute liver failure patients, and all of them survived. Conclusion: Total plasma exchange and continuous renal replacement therapy are life-saving, and both methods may reduce morbidity and mortality, also bridging to liver transplantation.

show abstract

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

Extracorporeal Therapies in Children with Acute Liver Failure: A Single-Center Experience

Gün¹,

Durak²,

Pervane³

et al. 2023

Turk J Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Volume resuscitation complications with massive transfusion protocol include volume overload leading to pulmonary edema (transfusion-associated circulatory overload), thrombosis, and transfusion-related acute lung injury. Liver disease with portal hypertension prompts cautious volume resuscitation similar to heart disease and renal failure [10]. If deliberate but cautious volume can be given safely (i.e., restrictive transfusion for goal 7-9 g/dL), it is favored to not increase intravascular pressure and exacerbate variceal bleeding [4].…”

Section: Objectivementioning

confidence: 99%

Severe Epistaxis in the Pediatric Patient: A Simulation for Emergency Department Management

Gorbatkin¹,

Pearce²,

Goldschmidt³

et al. 2022

Cureus

View full text Add to dashboard Cite

Severe, uncontrolled epistaxis in a pediatric patient can lead to a compromised bloody airway and the potential need for significant volume resuscitation secondary to hemorrhagic shock if not managed emergently. In this report, a simulated 11-month-old patient with underlying liver disease presents to the emergency department setting. The goal was to familiarize advanced pediatric emergency medicine trainees and experienced providers with immediate bedside interventions and clinical management steps for a patient with severe, difficult-to-control epistaxis to increase preparedness for future clinical scenarios. Additionally, this case highlights resuscitation considerations for patients with liver disease, including sources of bleeding, consulting services, medications, and approach to massive transfusion in liver disease.

show abstract

“…Acute liver failure can lead to many devastating complications, such as sepsis, coagulopathy, cerebral edema, renal and/or respiratory failure, hemodynamic instability, and aplastic anemia [7]. Cerebral edema and multiple organ dysfunction syndromes are the two major leading causes of death [8].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of acute liver failure in Egyptian children

Mansour,

Behairy,

Sira

et al. 2024

Egypt Liver Journal

View full text Add to dashboard Cite

Background Acute liver failure (ALF) is a serious condition that refers to the development of synthetic function impairment after severe acute liver injury in an individual without pre-existing liver disease. Understanding the epidemiology of ALF in children constitutes a cornerstone in its preventive and treatment plans. Nevertheless, there is a lack of information about its epidemiology in Egypt. Objective The aim of this study was to assess the epidemiologic data of ALF in Egyptian children. Patients and methods The medical records of children with ALF aged from 6 months to 18 years who were admitted from 2015 to 2020 were analyzed to identify the patient’s epidemiologic, laboratory, and investigational data together with their outcome. Results The study included 154 patients who fulfilled the definition of ALF were included. Their age ranged from 7 months to 17 years, with a median of 5.8 years. Hepatitis A virus (HAV) was the most commonly identifiable etiology (37.7%). Mortality was the outcome for 73 patients (47.4%). The prognostic factors associated with mortality were elevated international normalized ratio (INR), total bilirubin (TB), creatinine, and ammonia levels at presentation with cutoff values (2.97, 21.15, 0.385, and 212, respectively). Conclusion Hepatitis A virus is the most commonly identified etiology of ALF in Egyptian children. The mortality rate is high, and most of the deaths occurred early in the first 5 days of admission. So, early preparation for liver transplantation is recommended. Higher values of INR, TB, and creatinine above the cutoff levels at presentation may be potential markers for predicting death in affected children.

show abstract

Multiple organ involvement and ICU considerations for the care of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in children

Cited by 7 publications

References 59 publications

Extracorporeal Therapies in Children with Acute Liver Failure: A Single-Center Experience

Extracorporeal Therapies in Children with Acute Liver Failure: A Single-Center Experience

Severe Epistaxis in the Pediatric Patient: A Simulation for Emergency Department Management

Epidemiology of acute liver failure in Egyptian children

Contact Info

Product

Resources

About