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Acute Liver Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

James E Squires, Patrick J McKiernan, Robert H Squires

    Pediatrics
    |December 31, 2021
    PubMed

    Insights

    New criteria help identify acute liver dysfunction in critically ill children. These evidence-based guidelines aid in determining the need for urgent consultation with pediatric liver transplant centers for optimal patient outcomes.

    Area of Science:

    • Pediatric critical care medicine
    • Hepatology
    • Systematic review methodology

    Background:

    • Acute liver dysfunction is a critical condition in children requiring precise diagnostic criteria.
    • Current diagnostic standards may not fully capture the nuances of acute liver injury in critically ill pediatric populations.

    Purpose of the Study:

    • To develop evidence-based consensus criteria for acute liver dysfunction in critically ill children.
    • To establish clear guidelines for identifying children who may benefit from liver transplant evaluation.

    Main Methods:

    • Conducted systematic electronic searches of PubMed and Embase databases (1992-2020).
    • Included studies focused on critically ill children with acute liver dysfunction, excluding adults, premature infants, and non-English articles.
    • Utilized a data extraction form and risk of bias assessment by a task force.

    Main Results:

    • Proposed criteria for acute liver dysfunction include symptom onset <8 weeks, biochemical evidence of acute liver injury, and liver-based coagulopathy.
    • Hepatic encephalopathy is required for an international normalized ratio between 1.5 and 2.0 in the absence of chronic liver disease.
    • The criteria identify children at a clinical threshold for outcomes including native liver survival, death, or liver transplant.

    Conclusions:

    • The developed criteria aim to standardize the identification of acute liver dysfunction in pediatric critical care.
    • These criteria facilitate timely referral to pediatric liver transplant centers when liver failure drives multiple organ dysfunction.
    • Further research may be needed to address acute-on-chronic liver dysfunction and the subjective assessment of hepatic encephalopathy.
    Abstract

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