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Published on: November 27, 2019
Outcome predictors of fulminant hepatic failure in children
Pei-Chun Chan1, Huey-Ling Chen, Yen-Hsuan Ni
1Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Fulminant hepatic failure (FHF) in children has a high mortality rate. Elevated ammonia levels above 200 microM/L are a key indicator of poor prognosis, suggesting the need for timely liver transplantation.
Area of Science:
- Pediatric Hepatology
- Critical Care Medicine
- Transplantation Immunology
Background:
- Fulminant hepatic failure (FHF) in children presents a significant mortality risk.
- Early identification of pediatric FHF patients with poor prognosis is critical for timely liver transplantation referral.
Purpose of the Study:
- To evaluate clinical and laboratory features of pediatric FHF.
- To determine the correlation of these characteristics with patient outcomes.
Main Methods:
- Retrospective review of 31 pediatric FHF patients (1 month to 14 years).
- Analysis of 27 clinical and laboratory parameters using univariate and multivariate methods.
Main Results:
- Overall mortality rate was 71%.
- Higher mortality associated with older age, fever, elevated bilirubin and ammonia, and advanced encephalopathy.
- Peak ammonia level ≥ 200 microM/L was the sole independent predictor of mortality (93% vs. 43% mortality).
Conclusions:
- Childhood FHF carries a high mortality rate.
- Ammonia levels ≥ 200 microM/L strongly correlate with increased mortality.
- Liver transplantation is recommended for pediatric FHF patients with high ammonia levels.
Background And Purpose:
Mortality of fulminant hepatic failure (FHF) is high in children. It is crucial to identify patients with poor prognosis for timely referral to liver transplantation. This study aimed to assess the clinical and laboratory characteristics of children with FHF and evaluate their correlation with outcome.
Methods:
Retrospective review was conducted of a total of 31 pediatric patients aged 1 month to 14 years with a diagnosis of FHF from January 1984 to December 2001. Twenty seven clinical and laboratory parameters were analyzed using univariate and multivariate analysis.
Results:
The etiology of FHF was HBV infection in 10 patients, Wilson's disease in 3, enterovirus infection in 1, herpes simplex virus infection in 1, herpes simplex virus 6 infection with hemophagocytic syndrome in 1, leptospirosis infection in 1, and cryptogenic in 14. Overall mortality was 71% (22/31). The patients who eventually died tended to be older in age, were more likely to have fever during the disease course, had higher peak bilirubin, indirect bilirubin, and ammonia levels, and had more advanced stages of encephalopathy. Multivariate analysis revealed that peak ammonia level > or = 200 microM/L was the only independent factor significantly associated with mortality. The mortality rate in patients with ammonia levels > or = 200 microM/L was 93% compared to 43% in patients with ammonia levels < 200 microM/L (p = 0.013).
Conclusion:
Childhood FHF had a high mortality rate. Ammonia level > or = 200 microM/L was associated with a higher mortality rate. Liver transplantation is recommended for these patients.
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