Admission Characteristics Identify Risk of Pediatric Acute-on-Chronic Liver Failure.
Acute-On-Chronic Liver Failure
/ blood
Aspartate Aminotransferases
/ blood
Biliary Atresia
/ complications
Child
Child, Preschool
Creatinine
/ blood
End Stage Liver Disease
/ complications
Female
Hospital Mortality
Hospitalization
Humans
Infant
Intensive Care Units
International Normalized Ratio
Length of Stay
Liver
/ metabolism
Liver Cirrhosis
Male
Multiple Organ Failure
/ epidemiology
Patient Admission
Prognosis
Respiratory Insufficiency
/ epidemiology
Retrospective Studies
Risk Factors
Journal
Journal of pediatric gastroenterology and nutrition
ISSN: 1536-4801
Titre abrégé: J Pediatr Gastroenterol Nutr
Pays: United States
ID NLM: 8211545
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
pubmed:
7
3
2020
medline:
9
2
2021
entrez:
7
3
2020
Statut:
ppublish
Résumé
Acute-on-chronic liver failure (ACLF) is well-studied in adults and characterized by decompensated cirrhosis, multi-organ failure, and early mortality. Studies of ACLF in children are limited. We sought to characterize the prevalence and clinical factors associated with pediatric ACLF (PACLF). A retrospective review of children 3 months to 18 years listed for liver transplantation and hospitalized for decompensated cirrhosis between January 2007 and December 2017 at a single pediatric hospital. Primary outcome was the development of PACLF, characterized as failure of at least 1 extrahepatic organ (mechanical ventilation, renal replacement therapy, vasoactive medications, grade III/IV hepatic encephalopathy). Characteristics were recorded for each hospitalization. Sixty-six patients had 186 hospitalizations with mean age at admission 4.0 ± 5.6 years and diagnosis of biliary atresia (BA) in 65%. PACLF developed in 20 patients during 23 hospitalizations (12%) and respiratory failure was most common (17/23, 74%). Duration of intensive care unit stay, 13.1 ± 1.2 days versus 0.6 ± 0.6 days (P < 0.001) and length of stay, 24.3 ± 5.0 days versus 7.9 ± 1.9 days (P = 0.003) were longer in PACLF compared with non-PACLF. Mortality during PACLF hospitalizations was 22%. Clinical factors associated with PACLF were reported from a generalized linear mixed model and included increased admission creatinine (P < 0.0001), increased aspartate aminotransferase (AST) (P = 0.014), increased international normalized ration (INR) (P = 0.0015), and a positive blood culture (P = 0.007). In this pediatric series, PACLF developed in 12% of hospitalizations and mortality was high. Admission creatinine, AST, INR, and presence of a positive blood culture were associated with PACLF development.
Identifiants
pubmed: 32141996
doi: 10.1097/MPG.0000000000002695
pii: 00005176-202006000-00014
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Aspartate Aminotransferases
EC 2.6.1.1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
783-788Commentaires et corrections
Type : CommentIn
Type : CommentIn
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