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Pediatric acute liver failure: Etiology, outcomes, and the role of serial pediatric end‐stage liver disease scores
Author(s) -
Rajanayagam Jeremy,
Coman David,
Cartwright David,
Lewindon Peter J.
Publication year - 2013
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12083
Subject(s) - medicine , etiology , gastroenterology , liver disease , bilirubin , liver transplantation , biliary atresia , pediatrics , surgery , transplantation
To describe etiology, short‐term outcomes and prognostic accuracy of serial PELD scores in PALF . Retrospective analysis of children aged ≤16 yr, admitted with PALF under the QLTS, Brisbane, Australia, between 1991 and 2011. PELD ‐ MELD scores were ascertained at three time points (i) admission (ii), meeting PALF criteria, and (iii) peak value. Fifty‐four children met criteria for PALF , median age 17 months (1 day–15.6 yr) and median weight 10.2 kg (1.9–57 kg). Etiology was known in 69%: 26% metabolic, 15% infective, 13% drug‐induced, 6% autoimmune, and 9% hemophagocytic lymphohistiocytosis. Age <3 months and weight <4.7 kg predicted poor survival in non‐transplanted children. Significant independent predictors of poor outcome (death or LT ) were peak bilirubin > 220 μ m /L and peak INR > 4. Serial PELD ‐ MELD scores were higher in the 17 (32%) transplant recipients (mean: [i] 26.8, [ii] 31.8, [iii] 42.6); highest in the 12 (22%) non‐transplanted non‐survivors (mean: [i] 31.6, [ii] 37.2, [iii] 45.7) compared with the 25 (46%) transplant‐free survivors (mean: [i] 25.3, [ii] 26.0, [iii] 30.3). PELD ‐ MELD thresholds of ≥27 and ≥42 at (ii) meeting PALF criteria and (iii) peak predicted poor outcome (p < 0.001). High peak bilirubin and peak INR predict poor outcome and serial PELD ‐ MELD is superior to single admission PELD ‐ MELD score for predicting poor outcome.