Admission Characteristics Identify Risk of Pediatric Acute-on-Chronic Liver Failure

Area of Science:

• Pediatric Gastroenterology and Hepatology
• Critical Care Medicine
• Transplantation Medicine

Background:

• Acute-on-chronic liver failure (ACLF) is a severe clinical syndrome in adults with high mortality.
• Limited research exists on ACLF in pediatric populations, necessitating further characterization.
• Pediatric acute-on-chronic liver failure (PACLF) requires understanding of its prevalence and associated clinical factors.

Purpose of the Study:

• To determine the prevalence of PACLF in children.
• To identify clinical factors associated with the development of PACLF.
• To characterize the outcomes of PACLF hospitalizations in a pediatric cohort.

Main Methods:

• Retrospective review of pediatric patients (3 months–18 years) hospitalized for decompensated cirrhosis.
• Inclusion criteria: patients listed for liver transplantation between 2007–2017.
• PACLF defined by extrahepatic organ failure; data collected on patient characteristics and hospitalization outcomes.

Main Results:

• PACLF occurred in 12% of 186 hospitalizations across 66 patients, with respiratory failure being most common.
• PACLF hospitalizations showed significantly longer ICU and overall hospital stays.
• Factors associated with PACLF included elevated admission creatinine, AST, INR, and positive blood cultures.

Conclusions:

• PACLF represents a significant complication in pediatric patients with decompensated cirrhosis, occurring in 12% of hospitalizations.
• Mortality during PACLF hospitalizations was substantial.
• Elevated creatinine, AST, INR, and positive blood cultures are critical indicators for PACLF development in children.