A novel, bedside, etiology specific prognostic model (Peds-HAV) in hepatitis A induced pediatric acute liver failure

2020 ◽  
Vol 14 (4) ◽  
pp. 483-490
Author(s):  
Bikrant Bihari Lal ◽  
Vikrant Sood ◽  
Pandey Snehavardhan ◽  
Rajeev Khanna ◽  
Samba Siva Rao Pasupuleti ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Prognostic Model ◽  
Hepatitis A ◽  
Pediatric Acute Liver Failure

scholarly journals Prognostic Factors for Pediatric Acute Liver Failure: A Systematic Review and Meta-analysis of Prognostic Studies

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Junwen Mao ◽  
Junhua Chen ◽  
Zhu Chen
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Prognostic Model ◽  
Meta Analysis ◽  
The Poor ◽  
Grade 3 ◽  
Poor Outcomes ◽  
Pediatric Acute Liver Failure

Context: Pediatric acute liver failure (PALF) is a disease with high mortality, characterized by a multisystem disorder and acute liver dysfunction. Objectives: A systematic review and meta-analysis of prognostic studies is necessary to summarize the general prognostic factors for PALF. Also, these factors can contribute to the development of a new prognostic model. Methods: An electronic literature search was conducted systematically in PubMed, Embase and Cochrane databases to identify prognostic factors of pediatric acute liver failure and evaluate outcomes, including spontaneous survival, death without LT, and undergoing LT. Prospective or retrospective cohort designs were included. The methodological quality of studies was analyzed and scored, using the QUIPS tool. Also, a meta-analysis was performed to calculate the pooled odds ratio (OR) of the factors Results: 1465 citations were identified, 30 studies were reviewed, and 16 studies were included in the meta-analysis. The indicators extracted from the studies were divided into four categories: (1) general markers, (2) bio-markers, (3) scoring systems, and (4) treatments. Several prognostic factors were associated with the poor outcomes, including etiology (indeterminate disease and drugs), INR, ammonia, ALT levels, AST levels, bilirubin, albumin, severe HE (grade 3/4), sex (male), lactate. In addition, ammonia, bilirubin, albumin, AST levels, severe HE (grade 3/4) and etiology (indeterminate disease, drugs, metabolic disease) were associated with death (no LT). Conclusions: Etiology, ammonia, bilirubin, albumin, AST levels, severe HE (grade 3/4) were found associated with the poor outcomes or death (without LT) of PALF. Although these factors may contribute to the new prognostic model, they must be considered with caution. Further prognostic studies of PALF with larger cohorts are also needed.

Pediatric Acute Liver Failure and Immune Dysregulation

2014 ◽  
Vol 164 (2) ◽  
pp. 407-409 ◽  
Author(s):  
Frank DiPaola ◽  
Michael Grimley ◽  
John Bucuvalas
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Immune Dysregulation ◽  
Pediatric Acute Liver Failure

Liver Biopsy Can Be Safely Performed in Pediatric Acute Liver Failure to Aid in Diagnosis and Management

2018 ◽  
Vol 67 (4) ◽  
pp. 441-445 ◽  
Author(s):  
Catherine A. Chapin ◽  
Saeed Mohammad ◽  
Lee M. Bass ◽  
Sarah A. Taylor ◽  
Susan Kelly ◽  
...  
Keyword(s):  
Liver Biopsy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Diagnosis And Management ◽  
Pediatric Acute Liver Failure

scholarly journals Etiologies, Prognostic Factors, and Outcomes of Pediatric Acute Liver Failure in Thailand

2020 ◽  
Vol 23 (6) ◽  
pp. 539
Author(s):  
Songpon Getsuwan ◽  
Chatmanee Lertudomphonwanit ◽  
Pornthep Tanpowpong ◽  
Chollasak Thirapattaraphan ◽  
Thipwimol Tim-Aroon ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Pediatric Acute Liver Failure

Gamma-glutamyl transpeptidase is a useful predictor in evaluating the prognosis in pediatric acute liver failure

2019 ◽  
Author(s):  
Haiyan Fu ◽  
Ruiqin Zhao ◽  
Gelan Bai ◽  
Hui Zhou
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Serum Total Bilirubin ◽  
Gamma Glutamyl Transpeptidase ◽  
Cutoff Value ◽  
Gamma Glutamyl ◽  
Glutamyl Transpeptidase ◽  
Pediatric Acute Liver Failure

Abstract Background and objective: Pediatric acute liver failure (PALF) progresses rapidly and has a poor prognosis. Therefore, simple, sensitive and specific clinical indicators are needed. Gamma-glutamyl transpeptidase (GGT) plays a role in predicting the prognosis in infantile cholestatic liver diseases. However, its role in predicting the prognosis in PALF remains unclear. Methods: In present study, children with PALF were divided into a normal GGT group and a high GGT group using the GGT level of 50 U/L as the demarcation line. Age, sex, serum total bilirubin, direct bilirubin, albumin, total bile acid, international normalized ratio (INR) and pediatric end-stage liver disease (PELD) score were compared between the 2 groups. In addition, GGT level was subjected to receiver operating characteristic (ROC) curve analysis, and the area under the curve and the optimal diagnostic cutoff value were calculated. Results: A total of 41 children with PALF were enrolled in the study. INR, PELD score and mortality rate were significantly higher in the normal GGT group in comparison to the high GGT group. GGT level had area under the ROC curve of 0.8194 (95% CI : 0.680-0.959); the optimal diagnostic cutoff values were 60 U/L. At the cutoff value, the sensitivity and specificity of GGT level in predicting the prognosis in PALF were 86.36% and 73.68% respectively. Conclusion: GGT exhibited high sensitivity and specificity in predicting the prognosis in PALF. It can be used as one useful prognostic indicator of PALF.

scholarly journals Hemostatic Balance in Pediatric Acute Liver Failure: Epidemiology of Bleeding and Thrombosis, Physiology, and Current Strategies

2020 ◽  
Vol 8 ◽  
Author(s):  
Yonca Bulut ◽  
Anil Sapru ◽  
Gavin D. Roach
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Cell Activation ◽  
Protein S ◽  
Bleeding Risk ◽  
International Normalized Ratio ◽  
Clinical Syndrome ◽  
Low Grade ◽  
Endothelial Cell Activation ◽  
Pediatric Acute Liver Failure

Pediatric Acute Liver Failure (PALF) is a rapidly progressive clinical syndrome encountered in the pediatric ICU which may rapidly progress to multi-organ dysfunction, and on occasion to life threatening cerebral edema and hemorrhage. Pediatric Acute Liver Failure is defined as severe acute hepatic dysfunction accompanied by encephalopathy and liver-based coagulopathy defined as prolongation of International Normalized Ratio (INR) >1.5. However, coagulopathy in PALF is complex and warrants a deeper understanding of the hemostatic balance in acute liver failure. Although an INR value of >1.5 is accepted as the evidence of coagulopathy and has historically been viewed as a prognostic factor of PALF, it may not accurately reflect the bleeding risk in PALF since it only measures procoagulant factors. Paradoxically, despite the prolongation of INR, bleeding risk is lower than expected (around 5%). This is due to “rebalanced hemostasis” due to concurrent changes in procoagulant, anticoagulant and fibrinolytic systems. Since the liver is involved in both procoagulant (Factors II, V, IX, XI, and fibrinogen) and anticoagulant (Protein C, Protein S, and antithrombin) protein synthesis, PALF results in “rebalanced hemostasis” or even may shift toward a hypercoagulable state. In addition to rebalanced coagulation there is altered platelet production due to decreased thrombopoietin production by liver, increased von Willebrand factor from low grade endothelial cell activation, and hyperfibrinolysis and dysfibrinogenemia from altered synthetic liver dysfunction. All these alterations contribute to the multifactorial nature of coagulopathy in PALF. Over exuberant use of prophylactic blood products in patients with PALF may contribute to morbidities such as fluid overload, transfusion-associated lung injury, and increased thrombosis risk. It is essential to use caution when using INR values for plasma and factor administration. In this review we will summarize the complexity of coagulation in PALF, explore “rebalanced hemostasis,” and discuss the limitations of current coagulation tests. We will also review strategies to accurately diagnose the coagulopathy of PALF and targeted therapies.

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