Related Experiment Video

Updated: Dec 30, 2025

Author Spotlight: Evaluating Therapeutic Strategies to Enhance Liver Regeneration
05:25

Author Spotlight: Evaluating Therapeutic Strategies to Enhance Liver Regeneration

Published on: May 24, 2024

3.3K

Late-Onset Hepatic Failure in Children: Risk Factors that Determine the Outcome

Sumit Kumar Singh1, Moinak Sen Sarma1, Surender Kumar Yachha2

  • 1Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Digestive Diseases (Basel, Switzerland)
|January 16, 2020
PubMed

Insights

Pediatric late-onset hepatic failure (LOHF) outcomes are influenced by indeterminate etiology, infections, and acute kidney injury. A Pediatric End-Stage Liver Disease (PELD) score of 32 or higher effectively predicts poor outcomes in children with LOHF.

Area of Science:

  • Pediatric Hepatology
  • Liver Transplantation
  • Critical Care Medicine

Background:

  • Late-onset hepatic failure (LOHF) presents a unique challenge in pediatric liver disease management.
  • Limited pediatric experience necessitates better understanding of LOHF etiology and risk factors.
  • Identifying determinants of poor outcome (PO) is crucial for timely intervention in pediatric LOHF.

Purpose of the Study:

  • To identify the primary causes of pediatric LOHF.
  • To determine risk factors associated with poor outcomes in pediatric LOHF.
  • To evaluate the prognostic value of the Pediatric End-Stage Liver Disease (PELD) score and King's College Criteria (KCC).

Main Methods:

  • Defined LOHF as liver failure occurring 5-24 weeks post-jaundice without chronic liver disease.
  • Compared PO (death or liver transplant within 160 days) with spontaneous recovery (SR).
  • Applied PELD score and KCC for prognostic evaluation in 47 pediatric LOHF cases.

Main Results:

  • Hepatitis A was the most common cause (32%); 64% of cases had associated infections.
  • 25% of children achieved SR, while 60% experienced PO.
  • Multivariate analysis identified PELD score ≥32 as a significant predictor of PO (AUC 0.833).

Conclusions:

  • Indeterminate etiology, hepatic encephalopathy, infections, and acute kidney injury are linked to PO in pediatric LOHF.
  • A PELD score of 32 or higher is recommended for optimizing liver transplant listing.
  • A notable proportion of children with LOHF can achieve spontaneous recovery with native liver function.
Abstract

Keywords:
ChildrenHepatitisLate onsetLiver failure

More Related Videos

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen09:44

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen

Published on: November 27, 2019

10.8K
Implementation of Non-invasive Point of Care Transient Elastography for Evaluation of Liver Disease in Pediatric Populations with Cystic Fibrosis05:56

Implementation of Non-invasive Point of Care Transient Elastography for Evaluation of Liver Disease in Pediatric Populations with Cystic Fibrosis

Published on: August 29, 2025

389

Related Concept Videos

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
137
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
151
Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
172
Effect of Hepatic Disease on Pharmacokinetics: Active Drug, Metabolite and Fraction of Metabolized Drug01:14

Effect of Hepatic Disease on Pharmacokinetics: Active Drug, Metabolite and Fraction of Metabolized Drug

In pharmacotherapy, monitoring drug concentrations is paramount, especially for drugs whose therapeutic effects hinge on both the active compound and its metabolite. Hepatic impairment profoundly influences drug potency by altering liver function. If the drug is more potent than its metabolite, impaired liver function amplifies drug activity due to elevated drug concentration levels. Conversely, if the metabolite holds greater potency, diminished liver function diminishes drug activity by...
161
Hepatic Drug Excretion: Influencing Factors01:16

Hepatic Drug Excretion: Influencing Factors

The biliary system of the liver, crucial for bile secretion and drug excretion, comprises intrahepatic bile ducts that merge to form the common hepatic duct. This duct, carrying hepatic bile, combines with the cystic duct, draining the gallbladder and forming the common bile duct, which empties into the duodenum. Bile, produced by hepatic cells lining the bile canaliculi, is composed primarily of water, bile salts, pigments, electrolytes, and lesser amounts of cholesterol and fatty acids. Bile...
477
Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
205