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

Özçay, Figen; Öncel, Eda Karadağ; Barış, Zeren; Canan, Oğuz; Moray, Gökhan; Haberal, Mehmet

doi:10.5152/tjg.2016.16431

Cited by 14 publications

(10 citation statements)

References 29 publications

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“…However, relying solely on the KCHC to predict death may result in unnecessary liver transplantation in a child who may recover with supportive care. In some studies, PELD-MELD scores have been examined for their prognostic accuracy, either serial or at admission [11,24]. Rajanayagam et al .…”

Section: Discussionmentioning

confidence: 99%

Pediatric acute liver failure in Saudi Arabia: prognostic indicators, outcomes and the role of genetic testing

Alhadab¹,

AlShihabi²,

Mohamed³

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Objective The objective of this study was to determine the etiologies, outcomes, prognostic indicators and the role of genetic testing in children with acute liver failure (ALF). Methods This retrospective study included 46 patients with pediatric acute liver failure (PALF) according to the PALF study group definition, admitted to King Fahad Specialist Hospital-Dammam, Saudi Arabia, between January 2014 and December 2021. Patients who survived with supportive therapy were designated as the recovery group, whereas those who died or underwent liver transplantation were designated as the death/transplant group. Results There were 26 (56.5%) patients in the recovery group and 20 (43.5%) patients in the death/transplant group. Four patients (8.7%) underwent liver transplantation. After indeterminate causes (45.6%), genetic-metabolic diseases and drug-induced liver injury (DILI) were the most common cause with 15.2 and 13%, respectively. Genetic testing had a high yield of (6/31) in identifying monogenic disease associated with ALF. Younger age, lower Glasgow Coma Scale and higher international normalized ratio (INR) on admission were predictors for poor prognosis. The death/transplant group had longer intensive care unit stay (P < 0.001), and on admission they had more advanced hepatic encephalopathy (P < 0.005), more prolonged prothrombin time (P < 0.001), higher lactate (P < 0.006), higher total and direct bilirubin (P < 0.008) and (P < 0.001), respectively. Conclusion Genetic, metabolic and DILI causes constituted the most common cause of PALF after indeterminate causes. The use of genetic testing can improve diagnostic rates in special cases, but we could not assess the effect of genetic testing on prognosis. The overall survival rate in our study was 65.2%. Younger age, higher admission INR and lower Glasgow coma scale were indicators of poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Pediatric acute liver failure in Saudi Arabia: prognostic indicators, outcomes and the role of genetic testing

Alhadab¹,

AlShihabi²,

Mohamed³

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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“…In our study we found that INR of the non-survival group on admission was significantly higher than that of the survival group. This is in agreement with Özçay et al ., who found in their study on children with ALF that survivors had a significantly lower INR than that of non-survivors [ 28 ]. But this contrasts with the findings of Kaur et al ., who reported in a study on 43 children with ALF that INR cannot be used as a prognostic factor for ALF outcome [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric chronic liver failure-sequential organ failure assessment score and outcome of acute liver failure in children

Ayoub¹,

Ali²,

Rizk³

et al. 2020

ceh

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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%

“…Clinical and laboratory parameters are used to predict the evolution of ALF in children, such as encephalopathy, INR or coagulation factors V or VII [4][5][6][7][8]. King's College criteria and the Paediatric End-Stage Liver Disease (PELD) and Model for End-Stage Liver Disease (MELD) scores can be used to determine prognosis for the evolution of patients with ALF [9][10][11][12][13][14][15].…”

Section: Introductionmentioning

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

Cited by 14 publications

References 29 publications

Pediatric acute liver failure in Saudi Arabia: prognostic indicators, outcomes and the role of genetic testing

Pediatric acute liver failure in Saudi Arabia: prognostic indicators, outcomes and the role of genetic testing

Pediatric chronic liver failure-sequential organ failure assessment score and outcome of acute liver failure in children

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

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