Profile, risk factors and outcome of acute kidney injury in paediatric acute‐on‐chronic liver failure

Lal, Bikrant Bihari; Alam, Seema; Sood, Vikrant; Rawat, Dinesh; Khanna, Rajeev

doi:10.1111/liv.13693

Cited by 30 publications

(42 citation statements)

References 33 publications

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“…A cutoff score of 11 or more identified poor outcome with 87.5% sensitivity and 90.6% specificity. Poor outcome group showed a rise, while the good outcome group showed decline in AARC-ACLF score at day 4 (∆AARC-ACLF: Poor outcome: 1 ± 1.1 vs. Good outcome: − 0.6 ± 0.9, p < 0.0005) [204].…”

Section: Outcome and Prognostication In Pediatric Aclfmentioning

confidence: 88%

“…Serum creatinine (SCr) value included in AARC score is unreliable as children have lower SCr, which is further accentuated due to malnutrition, sarcopenia and decreased endogenous production. A pediatric modification of AARC score was made replacing the absolute SCr with grades of AKI [204]. Both the AARC score (AUROC 0.945) and its pediatric modification (AUROC 0.951) were superior to the other prognostic scores in pediatric ACLF cohort.…”

Section: Outcome and Prognostication In Pediatric Aclfmentioning

confidence: 98%

“…Theoretically, pediatric ACLF should have a better outcome than adults as the 2 commonest CLD, i.e., Wilson disease and autoimmune liver disease presenting as pediatric ACLF have specific medical therapy, better hepatic reserve (due to shorter duration of illness) and lesser incidence of comorbidities. Outcome has been defined at different time points in the published pediatric literature [195][196][197][198][199][200][201][202][203][204]. Wilson disease and cryptogenic cirrhosis have poor prognosis with 48.8% and 30% survival, respectively.…”

Section: Outcome and Prognostication In Pediatric Aclfmentioning

confidence: 99%

“…Outcome was poor in those with AKI and grade 3-4 HE. The presence of AKI increases the likelihood of death several folds [204]. Among the prognostic models evaluated in ACLF, APACHE-III, SOFA and CLIF SOFA score have been described in children [196,197].…”

Section: Outcome and Prognostication In Pediatric Aclfmentioning

confidence: 99%

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

et al. 2019

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the “APASL ACLF Research Consortium (AARC)” was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the ‘Golden Therapeutic Window’, extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.

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Section: Outcome and Prognostication In Pediatric Aclfmentioning

confidence: 88%

Section: Outcome and Prognostication In Pediatric Aclfmentioning

confidence: 98%

Section: Outcome and Prognostication In Pediatric Aclfmentioning

confidence: 99%

Section: Outcome and Prognostication In Pediatric Aclfmentioning

confidence: 99%

See 2 more Smart Citations

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

et al. 2019

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“…Pre-transplantation complications arise mainly at the cirrhosis stage. Death of children with acute decompensated cirrhosis has been reported to be of 33% and mortality increases with the number of failing organs [5,6]. A better understanding of the clinical pathway and unfavourable outcome in cirrhotic children, especially when admission to PICU is needed, could improve medical management as well as organ allocation prioritization in these children.…”

Section: Introductionmentioning

confidence: 99%

pCLIF-SOFA is a reliable outcome prognostication score of critically ill children with cirrhosis: an ESPNIC multicentre study

Claude

Deep

Kneyber

et al. 2020

Ann. Intensive Care

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Background and aims Data on outcome of critically ill children with cirrhosis are scarce. We aimed to evaluate the prognostic accuracy of sequential organs scoring systems in children with cirrhosis admitted to Paediatric Intensive Care Units (PICU). Methods We performed a multicentre retrospective analysis of children with cirrhosis admitted into four European PICUs between 2011 and 2016. Investigators were members of the ESPNIC liver failure and support working group. Paediatric End-Stage Liver Disease (PELD) and paediatric chronic liver failure sequential organ failure assessment score (pCLIF-SOFA) diagnostic accuracy for 28- and 60-day liver transplantation, 28-day mortality and 60-day composite outcome (ie. death or liver transplantation) were tested. Results One-hundred-and-thirty children were included. The main causes for PICU admission were acute-on-chronic liver failure (ACLF), gastrointestinal bleeding and sepsis. Twenty-nine percent died and 22.3% were transplanted by day-60 after PICU admission. On multivariable analysis, pCLIF-SOFA was the only predictor of mortality at day-28 and of composite outcome. Both pCLIF-SOFA and ACLF were independently associated with emergent liver transplantation. The pCLIF-SOFA score higher than 9 well predicted a 28-day mortality with a sensitivity of 87.8% and a specificity of 77.3%. A pCLIF-SOFA score higher than 7 was independently associated with liver transplantation on day-60. Stage 3 AKI assessed with KDIGO classification was significantly associated with 28-day mortality. Conclusions Half of critically ill cirrhotic children admitted to PICU either died or were transplanted within the initial 28-day period. On admission pCLIF-SOFA score accurately identify patients transplanted at day-28 and day-60 to those alive without LT and is associated with 28-day mortality and composite outcome at day-60.

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Acute kidney injury after living‐related liver transplantation in infants with biliary atresia: A retrospective study

Liu,

Dai,

Guo

et al. 2023

Pediatric Discovery

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Although acute kidney injury (AKI) is a frequent postoperative complication after liver transplantation, renal function following living‐related liver transplantation (LRLT) in infants remains understudied. The aim of this study was to identify the prevalence of AKI and the impact of AKI on outcomes in infant recipients with biliary atresia. We retrospectively reviewed infants who underwent LRLT surgery between January 2018 and January 2021. The primary outcome was the risk of postoperative AKI occurrence in the first 7 postoperative days. A multivariate regression analysis model was used to investigate risk factors for AKI, and the incidence and impacts of AKI on outcomes were analyzed. A total of 98 patients were included in the analysis. AKI occurred in 59 patients (60.2%) within 7 days after surgery. Logistic regression analysis revealed that preoperative transfusion (p < 0.05) and lower serum creatinine (SCr) (p < 0.05) were independent risk factors for AKI. The incidence of serious complications was significantly higher in the AKI group than in the non‐AKI group (p < 0.05). The postoperative mechanical ventilation time (p < 0.05) and hospital stay (p = 0.019) were significantly longer in the AKI group. There was no evidence of chronic kidney disease (CKD) in any surviving infants within 1 year after surgery. In conclusion, AKI is common in infant LRLT (60.2%), and preoperative transfusion and lower SCr levels were independently associated with AKI. AKI may be associated with the incidence of serious complications, prolonged use of ventilators, and hospital stays. No CKD occurred within 1 year.

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Profile, risk factors and outcome of acute kidney injury in paediatric acute‐on‐chronic liver failure

Cited by 30 publications

References 33 publications

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

pCLIF-SOFA is a reliable outcome prognostication score of critically ill children with cirrhosis: an ESPNIC multicentre study

Acute kidney injury after living‐related liver transplantation in infants with biliary atresia: A retrospective study

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