Predictors of outcome in acute-on-chronic liver failure in children

Abstract

Background and aims Acute-on-chronic liver failure (ACLF) is associated with a high mortality rate in the absence of liver transplantation. There is limited data on predictors of survival in ACLF in children. Therefore, we prospectively studied the predictors of outcome of ACLF in children. Methods A prospective evaluation of 31 children in the age group of 1-16 years who fulfilled the criteria for ACLF according to Asian Pacific Association for the Study of the Liver (APASL) 2008 consensus was done. All consecutive children were evaluated for etiology, diagnosis and severity of ACLF. For grading of organ dysfunction, the sequential organ failure assessment (SOFA) score was calculated. SOFA constitutes the parameters of respiration, coagulation, cardiovascular system, central nervous system, and renal and liver functions. We evaluated possible correlation between outcomes and different variables. Results Of the 31 children who fulfilled the criteria for ACLF, the common underlying chronic liver diseases (CLD) were autoimmune hepatitis (AIH) in 41.9% and Wilson disease in 41.9% of the patients. Superinfection with hepatitis A virus (HAV) (41.9%) was the most common etiology of acute deterioration. To find the best predictor for outcome, linear regression analysis was performed. Multivariate analysis revealed that the SOFA score and the International Normalized Ratio (INR) were predictors of survival. Six (19.4%) patients died. Causes of death were multiorgan failure in four and liver failure in two patients. Conclusion The mortality in ACLF is 19.4% and the causes of death were multiorgan failure and liver failure. The SOFA score and INR were predictors of outcome of ACLF in children.

Prognostic performance of clinical indices and model scorings for acute-on-chronic liver failure: A study of 164 patients

“…Complications such as bacterial or fungal infection, hepatic encephalopathy, HRS and electrolyte disturbance were also associated with poor prognosis. The results of the present investigation are concordant with those of Lal et al (15), who reported that high INR was an independent ACLF prognostic factor. Cellular immunity is impaired in patients with ACLF, increasing the risk of infection and the infection-associated mortality rate (16).…”

Clinical profile, natural history, and predictors of mortality in patients with acute-on-chronic liver failure (ACLF)

“…3Receiver operating characteristic curve of Acute Physiology and Chronic Health Evaluation (APACHE) II score the prognosis is determined by the degree of other organ system dysfunction and not by the severity of liver failure. Our findings are similar to those of other studies[1,2,4,[22][23][24][25][26][27][28][29][30].…”

Pediatric Acute‐on‐Chronic Liver Failure in a Specialized Liver Unit

“…A higher mortality of 50% is reported from adult data [2] as against the 39.3% of the pediatric cases having poor outcomes in the present study. The reported mortality of pediatric ACLF at two tertiary non-transplant Indian centres has been variable, ranging from 19.4% [9] to 59% [8]. The lower mortality of 19.4% [9] can be explained by exclusion of the more sick children from the cohort on account of referrals to the transplant centres.…”