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Published on: November 27, 2019
Clinical Profile and Outcomes of Children with Acute Liver Failure in a Tertiary Care Center in South India: A
Anitha Abimannane1, Bobbity Deepthi2, Rohit Bhowmick3
1Department of Pediatrics, Pondicherry Institute of Medical Sciences, Puducherry, India.
Insights
This study found that many children with acute liver failure (ALF) survive without liver transplantation (LT), especially with prompt intensive care. Infection and paracetamol overdose were common causes of ALF in children.
Area of Science:
- Pediatric Hepatology
- Clinical Pediatrics
- Gastroenterology
Background:
- Acute liver failure (ALF) in children presents a significant clinical challenge.
- Understanding the clinical profile and outcomes of pediatric ALF (PALF) is crucial for improving patient management.
- Liver transplantation (LT) is a life-saving option, but its accessibility varies.
Purpose of the Study:
- To investigate the clinical characteristics of pediatric acute liver failure (PALF).
- To determine survival rates at discharge for children with PALF.
- To assess the proportion of PALF patients meeting criteria for liver transplantation (LT) but surviving without it.
Main Methods:
- Retrospective review of medical records for children aged 28 days to 15 years over 7 years.
- Inclusion criteria: children meeting established criteria for PALF.
- Data collected included clinical profiles, causes, and outcomes (survival with or without LT).
Main Results:
- 71 children met PALF criteria; overall survival at discharge was 61%.
- 56.3% met King's College Criteria (KCC) and 7% met European Association for the Study of the Liver (EASL) criteria for LT.
- Survival without LT was 42.5% for KCC and 20% for EASL criteria; infection and paracetamol overdose were primary causes.
Conclusions:
- Pediatric ALF survival rates and profiles are evolving.
- Early referral to intensive care and LT services can improve outcomes in resource-limited settings.
- Preventive strategies and timely referrals are key to reducing PALF mortality.
Purpose:
In this study, we investigated the clinical profile, survival at discharge, and proportion of children with acute liver failure (ALF) meeting the criteria for, yet surviving without, liver transplantation (LT).
Methods:
Medical case records of children aged >28 days to ≤15 years over a period of 7 years, identified from pediatric admission and discharge registers, were screened. Children satisfying the criteria for ALF were included in this study.
Results:
A total of 71 records meeting the pediatric ALF (PALF) criteria were included. The survival rate at discharge was 61% (n=44). A considerable proportion of children satisfied the King's College Criteria (KCC) (56.3%) and the European Association for the Study of the Liver (EASL) criteria (7%) for LT at admission. Nonetheless, the survival rate in the absence of LT was 42.5% in children who satisfied the KCC and 20% in those who met the EASL criteria. Infection (29.5%) and paracetamol overdose (19.7%) were the major identifiable causes of PALF. Hepatitis A was the most common infection identified. No significant predictors of poor outcomes were identified in multivariable analysis.
Conclusion:
Our study highlights the changing survival rates and the clinical and etiological profiles of patients with PALF. In areas with poor access to LT services, survival in these children could be improved through early referral to centers with adequate intensive care facilities. Preventing ALF and referring patients to LT services are paramount to reducing mortality.
