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

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.