Pediatric acute liver failure: etiology, outcomes, and the role of serial pediatric end-stage liver disease scores

Rajanayagam, Jeremy, Coman, David, Cartwright, David and Lewindon, Peter J. (2013) Pediatric acute liver failure: etiology, outcomes, and the role of serial pediatric end-stage liver disease scores. Pediatric Transplantation, 17 4: 362-368. doi:10.1111/petr.12083


Author Rajanayagam, Jeremy
Coman, David
Cartwright, David
Lewindon, Peter J.
Title Pediatric acute liver failure: etiology, outcomes, and the role of serial pediatric end-stage liver disease scores
Journal name Pediatric Transplantation   Check publisher's open access policy
ISSN 1397-3142
1399-3046
Publication date 2013-06-01
Year available 2013
Sub-type Article (original research)
DOI 10.1111/petr.12083
Open Access Status Not Open Access
Volume 17
Issue 4
Start page 362
End page 368
Total pages 7
Place of publication Malden, MA, United States
Publisher Wiley-Blackwell
Language eng
Abstract To describe etiology, short-term outcomes and prognostic accuracy of serial PELD scores in PALF. Retrospective analysis of children aged ≤16 yr, admitted with PALF under the QLTS, Brisbane, Australia, between 1991 and 2011. PELD-MELD scores were ascertained at three time points (i) admission (ii), meeting PALF criteria, and (iii) peak value. Fifty-four children met criteria for PALF, median age 17 months (1 day–15.6 yr) and median weight 10.2 kg (1.9–57 kg). Etiology was known in 69%: 26% metabolic, 15% infective, 13% drug-induced, 6% autoimmune, and 9% hemophagocytic lymphohistiocytosis. Age <3 months and weight <4.7 kg predicted poor survival in non-transplanted children. Significant independent predictors of poor outcome (death or LT) were peak bilirubin > 220 μm/L and peak INR > 4. Serial PELD-MELD scores were higher in the 17 (32%) transplant recipients (mean: [i] 26.8, [ii] 31.8, [iii] 42.6); highest in the 12 (22%) non-transplanted non-survivors (mean: [i] 31.6, [ii] 37.2, [iii] 45.7) compared with the 25 (46%) transplant-free survivors (mean: [i] 25.3, [ii] 26.0, [iii] 30.3). PELD-MELD thresholds of ≥27 and ≥42 at (ii) meeting PALF criteria and (iii) peak predicted poor outcome (p < 0.001). High peak bilirubin and peak INR predict poor outcome and serial PELD-MELD is superior to single admission PELD-MELD score for predicting poor outcome.
Keyword Pediatric acute liver failure
Pediatric end-stage liver disease
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 15 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 18 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Sun, 30 Jun 2013, 10:20:27 EST by System User on behalf of School of Medicine