Prognostic factors in pediatric acute liver failure
Mirta Elba Ciocca 1*, Margarita D Ramonet 2, Miriam L Cuarterolo 1, Susana I López 1, Carolina Cernadas 1 and Fernando Álvarez 3
1 Hospital de Pediatría Juan P Garrahan, Argentina
2 Hospital Prof. A Posadas, Argentina
3 Hôpital Sainte Justine, Montreal, Canada
* To whom correspondence should be addressed. E-mail: mciocca{at}intramed.net.
Accepted 1 September 2007
 | Abstract |
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Objectives: To study the etiology, outcome and prognostic indicators in children with acute liver failure.
Study design: Retrospective chart review of 210 patients (107 males/ 103 females; median age: 5.33 years, range: 1 to 17.4). Patients were followed until discharge (Group 1), death (Group 2) or liver transplantation (Group 3). Data from Group 1 were compared to the other two and King's College criteria were also assessed.
Results: Final diagnosis was: 128 (61%) hepatitis A, 68 (32%) indeterminate, and 14 (7%) others. The characteristics of patients who survived (N: 59), died (N: 61), and underwent liver transplantation (N: 90) were analyzed. In multivariate analysis, prothrombin time and encephalopathy III/IV were the most significant parameters suggesting a high likelyhood of death. When King's College criteria were applied on admission in patients with and without transplantation, the positive predictive values were 96% and 95%, and the negative predictive values were 82% and 82%, respectively.
Conclusions: Hepatitis A is the main cause of acute liver failure in children in Argentina. Advanced encephalopathy and low prothrombin time level were significantly associated with death or need of liver transplantation. King's College criteria for predicting outcome of acute liver failure are applicable in children, including in children with acute liver failure due to hepatitis A infection.
Keywords:
encephalopathy, fulminant hepatic failure, liver transplantation, viral hepatitis
