Pediatric acute liver failure: Etiology, outcomes, and the role of serial pediatric end-stage liver disease scores
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), m...
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| Veröffentlicht in: | Pediatric transplantation 2013-06, Vol.17 (4), p.362-368 |
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| creator | Rajanayagam, Jeremy Coman, David Cartwright, David Lewindon, Peter J. |
| description | 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 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 |
| doi_str_mv | 10.1111/petr.12083 |
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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.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.12083</identifier><identifier>PMID: 23586473</identifier><language>eng</language><publisher>Denmark: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Child ; Child, Preschool ; End Stage Liver Disease - therapy ; Female ; Hepatic Encephalopathy - etiology ; Hepatic Encephalopathy - therapy ; Humans ; Infant ; Liver Failure, Acute - epidemiology ; Liver Failure, Acute - etiology ; Liver Failure, Acute - mortality ; Liver Failure, Acute - therapy ; Liver Transplantation ; Male ; pediatric acute liver failure ; pediatric end-stage liver disease ; Prognosis ; Queensland ; Referral and Consultation ; Registries ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Treatment Outcome</subject><ispartof>Pediatric transplantation, 2013-06, Vol.17 (4), p.362-368</ispartof><rights>2013 John Wiley & Sons A/S.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4693-6bd30bf07484562917e39e1b462536089764e4643cd532a3cc1e20071e3cc44b3</citedby><cites>FETCH-LOGICAL-c4693-6bd30bf07484562917e39e1b462536089764e4643cd532a3cc1e20071e3cc44b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpetr.12083$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpetr.12083$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23586473$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rajanayagam, Jeremy</creatorcontrib><creatorcontrib>Coman, David</creatorcontrib><creatorcontrib>Cartwright, David</creatorcontrib><creatorcontrib>Lewindon, Peter J.</creatorcontrib><title>Pediatric acute liver failure: Etiology, outcomes, and the role of serial pediatric end-stage liver disease scores</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplantation</addtitle><description>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.</description><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>End Stage Liver Disease - therapy</subject><subject>Female</subject><subject>Hepatic Encephalopathy - etiology</subject><subject>Hepatic Encephalopathy - therapy</subject><subject>Humans</subject><subject>Infant</subject><subject>Liver Failure, Acute - epidemiology</subject><subject>Liver Failure, Acute - etiology</subject><subject>Liver Failure, Acute - mortality</subject><subject>Liver Failure, Acute - therapy</subject><subject>Liver Transplantation</subject><subject>Male</subject><subject>pediatric acute liver failure</subject><subject>pediatric end-stage liver disease</subject><subject>Prognosis</subject><subject>Queensland</subject><subject>Referral and Consultation</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1397-3142</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1P3DAQhi1UxFd76Q9APlYVATvj2ElvFd3SIkShWujRcpwJGLzrre3Q7r9vYNk9di4zh-d9NHoJec_ZMR_nZIE5HvOS1bBF9jg0TQFMyDcvtyqAi3KX7Kf0wBiXohY7ZLeEqpZCwR6JV9g5k6Oz1NghI_XuCSPtjfNDxE90kl3w4W55RMOQbZhhOqJm3tF8jzQGjzT0NGF0xtPFxoTzrkjZ3K1tnUtoEtJkQ8T0lmz3xid897oPyM3XyfT0W3Hx4-z76eeLwgrZQCHbDljbMzW-XMmy4QqhQd4KWVYgWd0oKVBIAbaroDRgLceSMcVxPIVo4YB8WHkXMfweMGU9c8mi92aOYUiaQyVUU0KtRvTjCrUxpBSx14voZiYuNWf6uWP93LF-6XiED1-9QzvDboOuSx0BvgL-OI_L_6j01WT6cy0tVhmXMv7dZEx81FKBqvSvyzP95Rpup1Cf62v4BzeileY</recordid><startdate>201306</startdate><enddate>201306</enddate><creator>Rajanayagam, Jeremy</creator><creator>Coman, David</creator><creator>Cartwright, David</creator><creator>Lewindon, Peter J.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201306</creationdate><title>Pediatric acute liver failure: Etiology, outcomes, and the role of serial pediatric end-stage liver disease scores</title><author>Rajanayagam, Jeremy ; Coman, David ; Cartwright, David ; Lewindon, Peter J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4693-6bd30bf07484562917e39e1b462536089764e4643cd532a3cc1e20071e3cc44b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>End Stage Liver Disease - therapy</topic><topic>Female</topic><topic>Hepatic Encephalopathy - etiology</topic><topic>Hepatic Encephalopathy - therapy</topic><topic>Humans</topic><topic>Infant</topic><topic>Liver Failure, Acute - epidemiology</topic><topic>Liver Failure, Acute - etiology</topic><topic>Liver Failure, Acute - mortality</topic><topic>Liver Failure, Acute - therapy</topic><topic>Liver Transplantation</topic><topic>Male</topic><topic>pediatric acute liver failure</topic><topic>pediatric end-stage liver disease</topic><topic>Prognosis</topic><topic>Queensland</topic><topic>Referral and Consultation</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rajanayagam, Jeremy</creatorcontrib><creatorcontrib>Coman, David</creatorcontrib><creatorcontrib>Cartwright, David</creatorcontrib><creatorcontrib>Lewindon, Peter J.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rajanayagam, Jeremy</au><au>Coman, David</au><au>Cartwright, David</au><au>Lewindon, Peter J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric acute liver failure: Etiology, outcomes, and the role of serial pediatric end-stage liver disease scores</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplantation</addtitle><date>2013-06</date><risdate>2013</risdate><volume>17</volume><issue>4</issue><spage>362</spage><epage>368</epage><pages>362-368</pages><issn>1397-3142</issn><eissn>1399-3046</eissn><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.</abstract><cop>Denmark</cop><pub>Blackwell Publishing Ltd</pub><pmid>23586473</pmid><doi>10.1111/petr.12083</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Child Child, Preschool End Stage Liver Disease - therapy Female Hepatic Encephalopathy - etiology Hepatic Encephalopathy - therapy Humans Infant Liver Failure, Acute - epidemiology Liver Failure, Acute - etiology Liver Failure, Acute - mortality Liver Failure, Acute - therapy Liver Transplantation Male pediatric acute liver failure pediatric end-stage liver disease Prognosis Queensland Referral and Consultation Registries Retrospective Studies Severity of Illness Index Time Factors Treatment Outcome |
| title | Pediatric acute liver failure: Etiology, outcomes, and the role of serial pediatric end-stage liver disease scores |
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