Outcome predictors of fulminant hepatic failure in children.
OBJECTIVE
Mortality of fulminant hepatic failure (FHF) is high in children. It is crucial to identify patients with poor prognosis for timely referral to liver transplantation. This study aimed to assess the clinical and laboratory characteristics of children with FHF and evaluate their correlation with outcome.


METHODS
Retrospective review was conducted of a total of 31 pediatric patients aged 1 month to 14 years with a diagnosis of FHF from January 1984 to December 2001. Twenty seven clinical and laboratory parameters were analyzed using univariate and multivariate analysis.


RESULTS
The etiology of FHF was HBV infection in 10 patients, Wilson's disease in 3, enterovirus infection in 1, herpes simplex virus infection in 1, herpes simplex virus 6 infection with hemophagocytic syndrome in 1, leptospirosis infection in 1, and cryptogenic in 14. Overall mortality was 71% (22/31). The patients who eventually died tended to be older in age, were more likely to have fever during the disease course, had higher peak bilirubin, indirect bilirubin, and ammonia levels, and had more advanced stages of encephalopathy. Multivariate analysis revealed that peak ammonia level > or = 200 microM/L was the only independent factor significantly associated with mortality. The mortality rate in patients with ammonia levels > or = 200 microM/L was 93% compared to 43% in patients with ammonia levels < 200 microM/L (p = 0.013).


CONCLUSIONS
Childhood FHF had a high mortality rate. Ammonia level > or = 200 microM/L was associated with a higher mortality rate. Liver transplantation is recommended for these patients.
Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Pei-Chun
PC
Chan
Huey-Ling
HL
Chen
Yen-Hsuan
YH
Ni
Hong-Yuan
HY
Hsu
Luan-Yin
LY
Chang
Ping-Ing
PI
Lee
Mei-Hwei
MH
Chang
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology