1012 Serum Creatinine and the Presence of Encephalopathy at Presentation May Predict Mortality in Children With Acute Liver Failure

Stefanescu, Adrian; Pop, Tudor Lucian; Ştefănescu, Horia; Feier, Diana; Bizo, Aurel; N, Miu

doi:10.1016/s0168-8278(13)61014-4

Cited by 3 publications

(3 citation statements)

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“…Ganzert proved that the prothrombin index and serum creatinine were significantly better predictors than serum bilirubin and ALT [73]. In our previous works, in children mostly with ALF due to mushroom poisoning, serum creatinine and HE presence were found to predict mortality independently [75]. Moreover, in a study including 17 children with ALF due to mushroom poisoning, a PELD score over 20 had a 100% sensitivity and specificity to predict the fatal outcome, slightly better than KCC's 77.7% sensitivity and 100% specificity [76].…”

Section: Discussionmentioning

confidence: 82%

The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure

Pop

Aldea

Delean

et al. 2022

JCM

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Objectives: In children, acute liver failure (ALF) is a severe condition with high mortality. As some patients need liver transplantation (LT), it is essential to predict the fatal evolution and to refer them early for LT if needed. Our study aimed to evaluate the prognostic criteria and scores for assessing the outcome in children with ALF. Methods: Data of 161 children with ALF (54.66% female, mean age 7.66 ± 6.18 years) were analyzed based on final evolution (32.91% with fatal evolution or LT) and etiology. We calculated on the first day of hospitalization the PELD score (109 children), MELD, and MELD-Na score (52 children), and King’s College Criteria (KCC) for all patients. The Nazer prognostic index and Wilson index for predicting mortality were calculated for nine patients with ALF in Wilson’s disease (WD). Results: PELD, MELD, and MELD-Na scores were significantly higher in patients with fatal evolution (21.04 ± 13.28 vs. 13.99 ± 10.07, p = 0.0023; 36.20 ± 19.51 vs. 20.08 ± 8.57, p < 0.0001; and 33.07 ± 8.29 vs. 20.08 ± 8.47, p < 0.0001, respectively). Moreover, age, bilirubin, albumin, INR, and hemoglobin significantly differed in children with fatal evolution. Function to etiology, PELD, MELD, MELD-Na, and KCC accurately predicted fatal evolution in toxic ALF (25.33 vs. 9.90, p = 0.0032; 37.29 vs. 18.79, p < 0.0001; 34.29 vs. 19.24, p = 0.0002, respectively; with positive predicting value 100%, negative predicting value 88.52%, and accuracy 89.23% for King’s College criteria). The Wilson index for predicting mortality had an excellent predictive strength (100% sensibility and specificity), better than the Nazer prognostic index. Conclusions: Prognostic scores may be used to predict the fatal evolution of ALF in children in correlation with other parameters or criteria. Early estimation of the outcome of ALF is essential, mainly in countries where emergency LT is problematic, as the transfer to a specialized center could be delayed, affecting survival chances.

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Section: Discussionmentioning

confidence: 82%

The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure

Pop

Aldea

Delean

et al. 2022

JCM

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“…Various markers or scores are used to predict ALF outcomes. Extended prothrombin time (>50 s), low levels of plasma coagulation factors V and VII, cerebral oedema, severity of encephalopathy, sudden reduction in transaminases or liver size, high levels of α-fetoprotein (AFP), electrolyte disturbances, MELD and PELD scores and King's College criteria were studied as predictive factors for the evolution of ALF in children [4][5][6][9][10][11][23][24][25][26][27]. Clichy-Villejuif Criteria, with factor V levels as the main parameter, are used to decide the need for emergency liver transplant in ALF [5,[7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D-Binding Protein (Gc-Globulin) in Acute Liver Failure in Children

et al. 2020

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This study aimed to analyse vitamin D-binding protein (Gc-globulin) serum levels in acute liver failure (ALF) in children in relation to disease outcomes and correlations with other known markers used to evaluate the severity of ALF. Our study included 34 children (mean age 4.87 ± 5.30 years) with ALF of different causes (metabolic, 26.47%; autoimmune, 23.53%; toxic, 20.59%; infection, 17.65%; unknown, 11.76%) and 30 children without any liver injury (mean age 6.11 ± 4.26 years). The outcome was poor in 14 patients (41.18%), including one child with liver transplantation (2.94%). Serum Gc-globulin levels were significantly lower in ALF patients compared to the control group (151.57 ± 171.8 mg/L vs. 498.63 ± 252.50 mg/L; p < 0.000001), with an optimum cut-off of 163.5 mg/L (Area Under the Curve, AUC, 0.8921; sensitivity, 76.50%; specificity, 100%). Levels were also lower in patients with poor outcomes compared to survivors (59.34 ± 33.73 mg/L vs. 216.12 ± 199.69 mg/L; p < 0.0001), with an optimum cut-off 115 mg/L (AUC, 0.7642; sensitivity, 100%; specificity, 50%). Gc-globulin serum levels were variable according to ALF aetiology, i.e., lower in metabolic, infectious, or unknown causes compared to autoimmune and toxic causes. Gc-globulin serum levels were decreased in children with ALF and lower in those with poor outcomes compared with survivors. Gc-globulin serum levels were correlated with other known parameters used to evaluate the severity of ALF and could help to identify patients at high risk for poor outcomes.

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“…Another analysis of mushroom patients showed that high serum creatinine level and the presence of encephalopathy could predict mortality in children with ALF [15]. When analyzing the factors responsible for the difference between survival and fatal outcome in children with ALF, the most important were age, serum potassium level, and total bilirubin level (measured on the 3 rd day).…”

Section: Discussionmentioning

confidence: 99%

Acute liver failure secondary to toxic exposure in children

et al. 2019

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Introduction: Acute liver failure (ALF) is a syndrome defined by jaundice, coagulopathy (INR > 1.5) and hepatic encephalopathy in patients with no evidence of prior liver disease. Toxins and drugs are a frequent cause of ALF in children. Material and methods: The aim of our study was to establish the causes of toxic ALF in children followed up in our hospital in the period of January 2000 to August 2018. We retrospectively studied all hospital records of patients who developed ALF after mushroom/drug exposure and had been admitted to our hospital, the main pediatric toxicology center in northwestern Romania. Results: In the last 18 years, 123 patients were admitted to our clinic with toxic ALF (89 patients secondary to mushroom ingestion and 34 patients after drug exposure). In the 2000-2012 period accidental mushroom poisoning was the leading cause of toxic ALF. Unfortunately, during the last years, voluntary drug ingestions have increased dramatically. The most commonly incriminated drug was acetaminophen (52.94%). Conclusions: ALF in mushroom poisoning is associated with a high mortality in children, despite optimal medical therapy. This etiology was one of the most important causes of death in our cohort. The difficulty in accessing emergency liver transplantation is an obstacle common to many Eastern European pediatric centers. Fortunately, in the last 5 years the incidence of mushroom intoxications has decreased in our area. It is worrying that over the last few years there has been an increased incidence of toxic ALF after drug exposure (for suicidal purposes or due to lenient regulations for prescribing hepatotoxic medications).

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1012 Serum Creatinine and the Presence of Encephalopathy at Presentation May Predict Mortality in Children With Acute Liver Failure

Cited by 3 publications

References 0 publications

The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure

The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure

Vitamin D-Binding Protein (Gc-Globulin) in Acute Liver Failure in Children

Acute liver failure secondary to toxic exposure in children

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