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Published on: November 27, 2019
Coagulation Factors as Predictive Markers of Poor Outcomes in Children with Acute Liver Failure
Insights
Coagulation factors like Factor VII (FVII) and Factor V (FV), along with INR, effectively predict poor outcomes in children with acute liver failure (ALF). Monitoring these markers alongside liver function tests is crucial for managing ALF.
Area of Science:
- Pediatric Hepatology
- Clinical Biochemistry
- Transplantation Medicine
Background:
- Acute liver failure (ALF) in children is a critical condition with high mortality, especially when liver transplantation (LT) is not feasible.
- Predictive markers are essential for managing pediatric ALF and guiding treatment decisions.
- Current methods include clinical scores and criteria, but the role of specific coagulation factors requires further assessment.
Purpose of the Study:
- To evaluate the predictive value of coagulation factors (Factor V, Factor VII, INR) for poor outcomes in pediatric ALF.
- To compare the performance of coagulation factors with established scores (PELD, MELD) and criteria (King's College Hospital, Clichy) in predicting ALF outcomes.
Main Methods:
- A prospective study of 40 children diagnosed with ALF.
- Analysis of clinical and laboratory parameters, including plasma levels of Factor V (FV), Factor VII (FVII), and INR.
- Calculation and assessment of PELD, MELD, King's College Hospital (KCH), and Clichy criteria for predicting poor outcomes (emergency LT or death).
Main Results:
- Significantly lower FV and FVII levels were observed in children with poor outcomes compared to survivors.
- Higher maximum INR (INR-max) and PELD/MELD scores were associated with poor outcomes.
- FVII, FV, and INR-max demonstrated excellent performance in predicting poor outcomes, with high areas under the ROC curve.
- KCH criteria showed higher sensitivity but lower specificity than Clichy criteria.
Conclusions:
- Coagulation factors (INR, FV, FVII) are reliable predictive markers for fatal outcomes in pediatric ALF.
- Monitoring these coagulation parameters is recommended alongside standard liver function tests for comprehensive ALF management.
- These findings can aid in early identification of high-risk children requiring intensive monitoring or timely intervention.
Background:
In children, acute liver failure (ALF) is a severe condition associated with high mortality if an emergency liver transplantation (LT) is impossible. Clinical laboratory parameters and different scores or criteria are used to predict ALF evolution in children. We aimed to assess the role of coagulation factors as predictive markers of poor outcomes in children with ALF.
Methods:
The prospective study included 40 children with ALF, diagnosed based on the Pediatric ALF study group criteria. Patients with emergency LT or deceased were considered with poor outcomes. For all patients, we analyzed clinical and laboratory parameters (including plasma level of factor V (FV), factor VII (FVII), and INR). We calculated the PELD (Pediatric End-stage Liver Disease) and MELD (Model for End-stage Liver Disease) scores, King's College Hospital (KCH), and Clichy criteria. We analyzed their performance in predicting a poor outcome.
Results:
FV and FVII levels were significantly lower in children with poor outcomes than survivors (18.92 ± 19.95% vs. 10.72 ± 10.21%, p = 0.00139, respectively 46.51 ± 26.05% vs. 10.72 ± 10.21%, p = 0.00014). These parameters varied with ALF etiology, being the lowest in metabolic and infectious causes. The maximum value of INR (INR-max) was higher in children with poor outcomes than survivors (7.05 ± 3.20 vs. 2.96 ± 1.82, p = 0.000007), as it also was for the PELD/MELD score (30.06 ± 15.55 vs. 15.77 ± 9.64, p = 0.00092). FVII, FV, and INR-max had an excellent performance in predicting the poor outcome with an area under the ROC curve of 0.894, 0.816, and 0.861, respectively. KCH criteria had a higher sensitivity than Clichy criteria (92.86% vs. 50%) but lower specificity (53.85% vs. 95%).
Conclusions:
Our results support the role of coagulation factors (INR, FV, and FVII) as predictive markers for the fatal evolution of children with ALF and underlined the need for monitoring along with the usual liver function tests in children with ALF.
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