Skip to main content

Advertisement

SpringerLink
Log in

Etiology, outcome and prognostic indicators of acute liver failure in Asian children

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Objective

Outcome of pediatric acute liver failure (PALF) in countries with limited availability of LT is not well described. We evaluated the outcome and prognostic indicators of PALF in Malaysia where emergency LT for ALF is limited.

Methods

In this retrospective review on children < 18 years with PALF, we compared clinical and laboratory parameters between survival after supportive treatment and after LT or succumbed without LT. The predictive values of Liver Injury Unit (LIU; peak laboratory values for international normalized ratio [INR], ammonia, total bilirubin) and upon admission (aLIU) on outcome of PALF was evaluated using receiver operator characteristic (ROC) curves.

Results

Of 77 children (39 males [51%]; median age 2.8 years) with PALF, the overall survival was 55% (n = 42); 52% (n = 40) survived with supportive management, 2.6% (n = 2) after LT. As compared to children who survived without LT, children who had LT/died had lower hemoglobin, aspartate transferase, γ-glutamyl transpeptidase (GGT), and higher serum bilirubin, alkaline phosphatase, ammonia, and serum sodium (p < 0.05). On multivariate analysis, significant independent predictor for death or LT were peak bilirubin > 452 μmol/L and peak GGT < 96 IU/L. The C-index of LIU and aLIU score were 0.79 and 0.68, respectively, indicating that LIU score was a good model in predicting outcome of PALF.

Conclusions

Overall survival of PALF remained poor. High peak bilirubin and low GGT predict poor outcome of PALF. LIU score is a good model in predicting outcome of PALF and maybe useful in selecting children for emergency LT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Squires RH Jr, Shneider BL, Bucuvalas J, Alonso E, Sokol RJ, Narkewicz MR, et al. Acute liver failure in children: the first 348 patients in the pediatric acute liver failure study group. J Pediatr. 2006;148:652–658

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lee WS, McKiernan P, Kelly DA. Etiology, outcome and prognostic indicators of childhood fulminant hepatic failure in the United kingdom. J Pediatr Gastroenterol Nutr. 2005;40:575–581

    Article  PubMed  Google Scholar 

  3. Latif N, Mehmood K. Risk factors for fulminant hepatic failure and their relation with outcome in children. J Pak Med Assoc. 2010;60:175–178

    PubMed  Google Scholar 

  4. Bravo LC, Gregorio GV, Shafi F, Bock HL, Boudville I, Liu Y, et al. Etiology, incidence and outcomes of acute hepatic failure in 0–18 year old Filipino children. Southeast Asian J Trop Med Public Health. 2012;43:764–772

    PubMed  Google Scholar 

  5. Kaur S, Kumar P, Kumar V, Sarin SK, Kumar A. Etiology and prognostic factors of acute liver failure in children. Indian Pediatr. 2013;50:677–679

    Article  PubMed  Google Scholar 

  6. Durand P, Debray D, Mandel R, Baujard C, Branchereau S, Gauthier F, et al. Acute liver failure in infancy: a 14-year experience of a pediatric liver transplantation center. J Pediatr. 2001;139:871–876

    Article  CAS  PubMed  Google Scholar 

  7. Taylor SA, Whitington PF. Neonatal acute liver failure. Liver Transpl. 2016;22:677–685

    Article  PubMed  Google Scholar 

  8. Kulkarni S, Perez C, Pichardo C, Castillo L, Gagnon M, Beck-Sague C, et al. Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013. Pediatr Transpl. 2015;19:888–895

    Article  CAS  Google Scholar 

  9. Squires RH Jr. Acute liver failure in children. Semin Liver Dis. 2008;28:153–166

    Article  CAS  PubMed  Google Scholar 

  10. O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439–445

    Article  CAS  PubMed  Google Scholar 

  11. Sundaram V, Shneider BL, Dhawan A, Ng VL, Im K, Belle S, et al. King’s college hospital criteria for non-acetaminophen induced acute liver failure in an international cohort of children. J Pediatr. 2013;162:319–23.e1

    Article  PubMed  Google Scholar 

  12. Lu BR, Zhang S, Narkewicz MR, Belle SH, Squires RH, Sokol RJ. Evaluation of the liver injury unit scoring system to predict survival in a multinational study of pediatric acute liver failure. J Pediatr. 2013;162:1010–1016

    Article  PubMed  Google Scholar 

  13. Lee WS, Chai PF, Lim KS, Lim LH, Looi LM, Ramanujam TM. Outcome of biliary atresia in Malaysia: a single-centre study. J Paediatr Child Health. 2009;45(5):279–285

    Article  PubMed  Google Scholar 

  14. Lu BR, Gralla J, Liu E, Dobyns EL, Narkewicz MR, Sokol RJ. Evaluation of a scoring system for assessing prognosis in pediatric acute liver failure. Clin Gastroenterol Hepatol. 2008;6:1140–1145

    Article  PubMed  PubMed Central  Google Scholar 

  15. Meyers LS, Gamst G, Guarino AJ. Applied multivariate research: design and interpretation. Thousand Oaks: SAGE Publications, Inc.; 2017. p. 367–376

    Google Scholar 

  16. Kathemann S, Bechmann LP, Sowa JP, Manka P, Dechêne A, Gerner P, et al. Etiology, outcome and prognostic factors of childhood acute liver failure in a German single center. Ann Hepatol. 2015;14:722–728

    Article  CAS  PubMed  Google Scholar 

  17. Rajanayagam J, Coman D, Cartwright D, Lewindon PJ. Pediatric acute liver failure: etiology, outcomes, and the role of serial pediatric end-stage liver disease scores. Pediatr Transpl. 2013;17:362–368

    Article  CAS  Google Scholar 

  18. Squires JE, Rudnick DA, Hardison RM, Horslen S, Ng VL, Alonso EM, et al. Liver transplant listing in pediatric acute liver failure: practices and participant characteristics. Hepatology. 2018;68:2338–2347

    Article  CAS  PubMed  Google Scholar 

  19. Alam S, Khanna R, Sood V, Lal BB, Rawat D. Profile and outcome of first 109 cases of paediatric acute liver failure at a specialized paediatric liver unit in India. Liver Int. 2017;37:1508–1514

    Article  CAS  PubMed  Google Scholar 

  20. Dhawan A. Etiology and prognosis of acute liver failure in children. Liver Transpl. 2008;14:S80–S84

    Article  PubMed  Google Scholar 

  21. Zhao P, Wang CY, Liu WW, Wang X, Yu LM, Sun YR. Acute liver failure in Chinese children: a multicenter investigation. Hepatobiliary Pancreat Dis Int. 2014;13:276–280

    Article  CAS  PubMed  Google Scholar 

  22. Chongsrisawat V, Hutagalung Y, Poovorawan Y. Liver function test results and outcomes in children with acute liver failure due to dengue infection. Southeast Asian J Trop Med Public Health. 2009;40:47–53

    PubMed  Google Scholar 

  23. Lum L, Lam S, George R, Devi S. Fulminant hepatitis in dengue infection. Southeast Asian J Trop Med Public Health. 1993;24:476–471

    Google Scholar 

  24. Tan S-S, Bujang MA. The clinical features and outcomes of acute liver failure associated with dengue infection in adults: a case series. Braz J Infect Dis. 2013;17:164–169

    Article  PubMed  PubMed Central  Google Scholar 

  25. Poovorawan Y, Hutagalung Y, Chongsrisawat V, Boudville I, Bock HL. Dengue virus infection: a major cause of acute hepatic failure in Thai children. Ann Trop Paediat. 2006;26:17–23

    Article  Google Scholar 

  26. Chien M-M, Chang M-H, Chang K-C, Lu F-T, Chiu Y-C, Chen H-L, et al. Prognostic parameters of pediatric acute liver failure and the role of plasma exchange. Pediatr Neonatol. 2019;60:389–395

    Article  PubMed  Google Scholar 

  27. Dhawan A, Cheeseman P, Mieli-Vergani G. Approaches to acute liver failure in children. Pediatr Transplant. 2004;8:584–588

    Article  PubMed  Google Scholar 

  28. Li R, Belle SH, Horslen S, Chen LW, Zhang S, Squires RH. Clinical course among cases of acute liver failure of indeterminate diagnosis. J Pediatr. 2016;171:163–170 (e1–3)

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors have not disclosed any funding.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Ruey Terng Ng, Kee Seang Chew, Chee Liang Choong, Zhi Liang Song, Zhong Ling Koay & Way Seah Lee

  2. School of Mathematical Sciences, Sunway University, Bandar Sunway, Malaysia

    Jane Kimm Lii Teh

  3. Department of Medical Research, Pantai Hospital, Kuala Lumpur, Malaysia

    Shin Yee Wong

  4. Unit of Gastroenterology and Hepatology, Tunku Azizah Women’s and Children’s Hospital, Kuala Lumpur, Malaysia

    Choy Chen Kam

  5. Department of Paediatrics, Faculty of Medicine, MARA University of Technology, Shah Alam, Malaysia

    Norashikin Binti Mohd Ranai

Authors
  1. Ruey Terng Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kee Seang Chew
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chee Liang Choong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhi Liang Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jane Kimm Lii Teh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhong Ling Koay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shin Yee Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Choy Chen Kam
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Norashikin Binti Mohd Ranai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Way Seah Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by RTN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ruey Terng Ng.

Ethics declarations

Conflict of interest

Ruey Terng Ng The authors declare that no funds and grants were received during the preparation of this manuscript. Kee Seang Chew The authors declare that no funds and grants were received during the preparation of this manuscript. Chee Liang Choong The authors declare that no funds and grants were received during the preparation of this manuscript. Zhi Liang Song The authors declare that no funds and grants were received during the preparation of this manuscript. Jane Kimm Lii Teh The authors declare that no funds and grants were received during the preparation of this manuscript. Zhong Ling Koay The authors declare that no funds and grants were received during the preparation of this manuscript. Shin Yee Wong The authors declare that no funds and grants were received during the preparation of this manuscript. Choy Chen Kam The authors declare that no funds and grants were received during the preparation of this manuscript. Norashikin Binti Mohd Ranai The authors declare that no funds and grants were received during the preparation of this manuscript. Way Seah Lee The authors declare that no funds and grants were received during the preparation of this manuscript.

Ethical approval

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. Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ng, R.T., Chew, K.S., Choong, C.L. et al. Etiology, outcome and prognostic indicators of acute liver failure in Asian children. Hepatol Int 16, 1390–1397 (2022). https://doi.org/10.1007/s12072-022-10417-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-022-10417-5

Keywords

Search

Navigation