Prognostic factors in paediatric acute liver failure

Abstract

Hepatitis A is the main cause of ALF in children in Argentina. Advanced encephalopathy and prolonged prothrombin time were significantly associated with death or need for LT. King's College criteria for predicting the outcome of ALF are applicable in children, including those with ALF due to hepatitis A infection.

Etiologies, outcomes, and prognostic factors of pediatric acute liver failure: A single center’s experience in Turkey

“…Spontaneous survival without LT was 40.6% in the patients included in our study, which is higher than that in previous reports (28%, 32.4%, 33%, respectively) (2,7,10). Early referral of patients with PALF and improved intensive care supportive treatment lead to an increased spontaneous survival rate (14).…”

“…The low rate of hepatitis B in children may possibly be attributed to the successful national HBV vaccination program, which has been in effect since 1998. In most countries in northern Europe, and in North and South America (2,4,10,23,24), indeterminate causes predominate in ALF in childhood, whereas acetaminophen toxicity was the most common identifiable cause of ALF in older children. In our study, etiology remained indeterminate in 33% of patients.…”

“…The duration of illness before the onset of HE and the degree of HE at the time of presentation have been extensively investigated in numerous studies (2,25,31). Patients with the rapid development of HE after the onset of clinical disease were found to more likely survive without LT. A study from Argentina (2) showed that one of the most significant indicators of a poor prognosis was grade 3 to 4 HE.…”

“…Age and geographical location affect the etiology of PALF. In developing countries, hepatitis A is the most significant etiological agent causing acute liver failure (ALF) in children (2,3); however, infectious causes are rarely seen in developed countries (4). Pediatric ALF Study Group data (4) indicated that metabolic diseases were the most common cause of ALF in children under 3 years.…”

“…With improvement in supportive therapy and LT, overall survival rates have increased to 62-83% (4,10,11). Diverse combinations of age, etiologies of ALF, onset and peak grade of hepatic encephalopathy (HE), biochemical tests [prothrombin time (PT), the international normalized ratio (INR), bilirubin, ammonia, and lactate], Pediatric End-Stage Liver Disease (PELD) score, several chemokines, cytokines, and reactive nitrogen oxide species have been evaluated to assess the prognosis of PALF (2,12,13). Applying King's College Hospital Criteria to children with PALF did not predict death, and the reported positive predictive value was only 33% (14).…”