Abstract
Background
Hepatitis A virus (HAV) is the commonest cause of pediatric acute liver failure (PALF) in developing countries. Our objective was to develop and validate a HAV-etiology specific prognostic model in PALF.
Methods
All children with HAV induced PALF (IgM HAV reactive) were included. Outcome was defined at day 28. Only those with death or native liver survival were included. The model (Peds-HAV) was derived using the independent predictors of outcome and validated in a prospective independent cohort.
Results
Hepatitis A accounted for 131 (45.9%) of total 285 PALF. After excluding 11 children who underwent liver transplant, 120 children (74 survivors and 46 death) were included. The first 75 patients formed the derivation cohort and the next 45 patients formed the prospective validation cohort. In the derivation cohort, INR: OR 2.208, (95% CI 1.321–3.690), p = 0.003, grade of hepatic encephalopathy (HE): OR 3.078, (95% CI 1.017–9.312), p = 0.047 and jaundice-to-HE interval: OR 1.171, (95% CI 1.044–1.314), p = 0.007 were independent predictors of death. The final model comprised three criteria: (1) presence of grade 3–4 HE, (2) INR greater than 3.1, and (3) jaundice to HE interval more than 10 days. Presence of 2 or more of these criteria predicted death with 90% sensitivity, 81.4% specificity and 84.9% accuracy. Peds-HAV model was superior to existing prognostic models. In the validation cohort, Peds-HAV model predicted death with 83.3% sensitivity and 92.6% specificity.
Conclusion
Peds-HAV model is a simple, bedside, dynamic, etiology (HAV) specific prognostic model based on 3 objective parameters with optimum sensitivity and specificity, hence should be used as liver transplant listing criteria in HAV induced PALF.
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Bikrant Bihari Lal, Vikrant Sood, Snehavardhan Pandey, Rajeev Khanna, Samba Siva Rao Pasupuleti, Manish Siloliya, Guresh Kumar and Seema Alam declare no conflict of interest.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Ethical approval was obtained from the institutional ethical committee (IEC/2019/66/ MA04).
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Informed consent was obtained from all patients included in prospective part of study.
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12072_2020_10050_MOESM3_ESM.tif
Supplementary Figure 3: Hypothetical scenario showing listing and mortality based on Peds-HAV model at each day from day of admission (day 0) to day 7 and corresponding outcome of the patients at each day. The curved arrows indicate patients that would have been listed or delisted from days 0 to 7 (TIF 1052 kb)
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Lal, B.B., Sood, V., Snehavardhan, P. et al. A novel, bedside, etiology specific prognostic model (Peds-HAV) in hepatitis A induced pediatric acute liver failure. Hepatol Int 14, 483–490 (2020). https://doi.org/10.1007/s12072-020-10050-0
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DOI: https://doi.org/10.1007/s12072-020-10050-0