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A novel, bedside, etiology specific prognostic model (Peds-HAV) in hepatitis A induced pediatric acute liver failure

Bikrant Bihari Lal1, Vikrant Sood1, Pandey Snehavardhan1

  • 1Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.

Hepatology International
|May 7, 2020
PubMed

Insights

A new Peds-HAV model accurately predicts death in children with Hepatitis A-induced acute liver failure. This simple, bedside tool uses three objective parameters to guide transplant listing decisions.

Area of Science:

  • Hepatology
  • Pediatric Gastroenterology
  • Virology

Background:

  • Hepatitis A virus (HAV) is a leading cause of pediatric acute liver failure (PALF) in developing nations.
  • Developing an etiology-specific prognostic model for HAV-induced PALF is crucial for patient management.

Purpose of the Study:

  • To develop and validate a prognostic model specifically for pediatric acute liver failure caused by Hepatitis A virus.
  • To identify independent predictors of mortality in children with HAV-induced PALF.

Main Methods:

  • A cohort of children with HAV-induced PALF was analyzed.
  • A prognostic model (Peds-HAV) was derived using independent predictors of 28-day outcomes (death or native liver survival).
  • The model was validated prospectively in an independent cohort.

Main Results:

  • Hepatitis A accounted for 45.9% of PALF cases.
  • The Peds-HAV model identified Grade 3-4 hepatic encephalopathy (HE), INR > 3.1, and jaundice-to-HE interval > 10 days as predictors of death.
  • The model demonstrated high sensitivity (83.3-90%) and specificity (81.4-92.6%) in predicting death in both derivation and validation cohorts.

Conclusions:

  • The Peds-HAV model is a simple, dynamic, and etiology-specific prognostic tool for HAV-induced PALF.
  • Its optimal sensitivity and specificity support its use as a criterion for liver transplant listing in these patients.
Abstract

Keywords:
Acute liver failureEtiologyHepatic encephalopathyHepatitis AInternational normalized ratioJaundice to encephalopathy intervalLiver transplantOutcomePediatricPrognosis

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