Etiology, outcome and prognostic indicators of acute liver failure in Asian children

• Main Authors: Ng, Ruey Terng, Chew, Kee Seang, Choong, Chee Liang, Song, Zhi Liang, Teh, Jane Kimm Lii, Koay, Zhong Lin, Wong, Shin Yee, Kam, Choy Chen, Ranai, Norashikin Binti Mohd, Lee, Way Seah
• Format: Article
• Published: Springer 2022
• Subjects: Theories of disease. Etiology. Pathogenesis
• Online Access: http://eprints.um.edu.my/46251/; https://doi.org/10.1007/s12072-022-10417-5

Objective Outcome of pediatric acute liver failure (PALF) in countries with limited availability of LT is not well described. We evaluated the outcome and prognostic indicators of PALF in Malaysia where emergency LT for ALF is limited. Methods In this retrospective review on children < 18 years with PALF, we compared clinical and laboratory parameters between survival after supportive treatment and after LT or succumbed without LT. The predictive values of Liver Injury Unit (LIU; peak laboratory values for international normalized ratio INR], ammonia, total bilirubin) and upon admission (aLIU) on outcome of PALF was evaluated using receiver operator characteristic (ROC) curves. Results Of 77 children (39 males 51%]; median age 2.8 years) with PALF, the overall survival was 55% (n = 42); 52% (n = 40) survived with supportive management, 2.6% (n = 2) after LT. As compared to children who survived without LT, children who had LT/died had lower hemoglobin, aspartate transferase, gamma-glutamyl transpeptidase (GGT), and higher serum bilirubin, alkaline phosphatase, ammonia, and serum sodium (p < 0.05). On multivariate analysis, significant independent predictor for death or LT were peak bilirubin > 452 mu mol/L and peak GGT < 96 IU/L. The C-index of LIU and aLIU score were 0.79 and 0.68, respectively, indicating that LIU score was a good model in predicting outcome of PALF. Conclusions Overall survival of PALF remained poor. High peak bilirubin and low GGT predict poor outcome of PALF. LIU score is a good model in predicting outcome of PALF and maybe useful in selecting children for emergency LT.