Prognostic of pediatric patients with acute liver failure: A cohort study

Abstract

Introduction: Acute liver failure (ALF) is a rapidly progressive and multisystem syndrome with high mortality. Objective: To determine prognostic factors of poor outcome in children with ALF. Material and methods: This is a retrospective cohort study with children under 14 years of age. In order to compare clinical and laboratory factors, patients were grouped according to their prognosis, favorable (recovery) and unfavorable (death or need for liver transplantation [LT]). Cox proportional risk analysis was used to determine the association of factors associated with prognosis. Results: 44 patients were included. In the majority, the etiology of ALF could not be identified (56.8%). Fifteen patients (34.1%) had a favorable evolution, and 29 (65.9%) had a poor evolution: 15 died and 14 met LT criteria. In the multivariate model, the poor prognostic factors were: INR (international normalized ratio) > 3.5 (HR = 2.235; 95% CI: 1.722-6.914; p = 0.043) and a higher LIU score (Liver Injury Unit scoring system) (HR = 2.0; 95% CI: 1.996-2.005; p = 0.049). Conclusions: Mortality in children with ALF is high. Factors associated with an unfavorable evolution were INR > 3.5 or high LIU scores.