Prognostic factors in paediatric acute liver failure

Objectives: To study the aetiology, outcome and prognostic indicators in children with acute liver failure (ALF). Study design: Retrospective chart review of 210 patients (107 males/103 females; median age: 5.33 years, range: 1-17.4). Patients were followed until discharge (group 1), death (group 2) or liver transplantation (LT; group 3). Data from group 1 were compared to data from the other two groups and King's College criteria were also assessed. Results: Final diagnoses were: 128 (61%) hepatitis A, 68 (32%) indeterminate and 14 (7%) others. The characteristics of patients who survived (n=59), died (n=61) and underwent LT (n=90) were analysed. In multivariate analysis, prothrombin time and encephalopathy III/IV were the most significant parameters suggesting a high likelihood of death. When King's College criteria were applied on admission in patients with and without transplantation, the positive predictive values were 96% and 95%, and the negative predictive values were 82% and 82%, respectively. Conclusions: Hepatitis A is the main cause of ALF in children in Argentina. Advanced encephalopathy and prolonged prothrombin time were significantly associated with death or need for LT. King's College criteria for predicting the outcome of ALF are applicable in children, including those with ALF due to hepatitis A infection.