Prognostic Factors in Children with Acute Liver Failure

Introduction: Acute liver failure (ALF) in children is a severe condition with extremely high mortality (50%) in the absence of emergency liver transplantation, an intervention that can be the only definitive treatment for these patients. Several prognostic scores or markers were developed, (e.g. age, aetiology, hepatic encephalopathy, INR, albumin, bilirubin) but so far there is no universally valid criterion for assessing the prognosis of a child with ALF.

Material and methods: This retrospective study (2014-2019) includes children hospitalized in the Emergency Clinic Hospital for Children Cluj-Napoca with ALF. We have analyzed the serum levels of the main liver function parameters (transaminases, bilirubin, INR) at the admission, the maximum value, and their growth rates. We correlated these parameters with the evolution of ALF.

Results: During the last 5 years, 65 children were hospitalized: 35 boys (53.85%) and 30 girls (46.15%), mean age 4.16 years. In our cohort, 29 patients died (44.61%), 3 patients (4.61%) had liver transplantation and 33 children (50.76%) survived. The serum level of transaminases at admission, the maximum values and the growth rate did not significantly differ with the evolution of ALF. Instead, the level on the first day, maximum values of INR and bilirubin, and the growth rate of bilirubin are significantly higher in patients with unfavorable evolution (died and transplanted). For this reason, they could be considered factors that predict disease evolution.

Conclusion: Our analysis highlights the usefulness of some laboratory parameters in predicting the evolution of ALF in children. Children who needed a transplant or those who died had significantly higher values of these parameters than those who survived.