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Pediatric Acute-on-Chronic Liver Failure in a Specialized Liver Unit: Prevalence, Profile, Outcome, and Predictive

Seema Alam1, Bikrant B Lal, Vikrant Sood

  • 1Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

Journal of Pediatric Gastroenterology and Nutrition
|March 12, 2016
PubMed

Insights

Pediatric acute-on-chronic liver failure (ACLF) affects 11.2% of children with chronic liver disease, with a 61% survival rate. A high Chronic Liver Failure-Sequential Organ Failure Assessment score predicts mortality.

Area of Science:

  • Pediatric Hepatology
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Pediatric acute-on-chronic liver failure (ACLF) is a severe condition with high mortality.
  • Understanding its prevalence, characteristics, and predictors is crucial for improving outcomes in children with chronic liver disease (CLD).

Purpose of the Study:

  • To determine the prevalence, clinical profile, and outcomes of pediatric ACLF.
  • To identify factors that predict mortality in children with ACLF.

Main Methods:

  • A study included 499 children with CLD, identifying 56 (11.2%) with ACLF based on established criteria.
  • Data were collected retrospectively and prospectively between January 2011 and October 2015.
  • Outcomes were defined as survival with native liver at 90 days or death/liver transplantation.

Main Results:

  • The mean age of children with ACLF was 9.35 years, with Wilson disease and autoimmune hepatitis being the most common underlying CLDs.
  • Disease flare-ups and acute viral hepatitis were the primary triggers for ACLF.
  • Poor outcomes (death or transplantation) occurred in 39.3% of cases, associated with severe hepatic encephalopathy, high bilirubin, elevated INR, and multiple organ failures.

Conclusions:

  • Pediatric ACLF has an 11.2% prevalence among children with CLD, with a 61% 90-day survival rate.
  • A Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) score of ≥10 is a strong predictor of 90-day mortality.
Abstract

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