title: Acute liver failure in children: the first 348 patients in the pediatric acute liver failure study group.
abstract: OBJECTIVE
  To determine short-term outcome for children with acute liver failure (ALF) as it relates to cause, clinical status, and patient demographics and to determine prognostic factors.
  
  
  METHODS
  A prospective, multicenter case study collecting demographic, clinical, laboratory, and short-term outcome data on children from birth to 18 years with ALF. Patients without encephalopathy were included if the prothrombin time and international normalized ratio remained > or = 20 seconds and/or >2, respectively, despite vitamin K. Primary outcome measures 3 weeks after study entry were death, death after transplantation, alive with native liver, and alive with transplanted organ.
  
  
  RESULTS
  The cause of ALF in 348 children included acute acetaminophen toxicity (14%), metabolic disease (10%), autoimmune liver disease (6%), non-acetaminophen drug-related hepatotoxicity (5%), infections (6%), other diagnosed conditions (10%); 49% were indeterminate. Outcome varied between patient sub-groups; 20% with non-acetaminophen ALF died or underwent liver transplantation and never had clinical encephalopathy.
  
  
  CONCLUSIONS
  Causes of ALF in children differ from in adults. Clinical encephalopathy may not be present in children. The high percentage of indeterminate cases provides an opportunity for investigation.
authors.affiliation: University of Pittsburgh, Children's Hospital of Pittsburgh, PA 15213, USA. Robert.squires@chp.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Squires
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Shneider
authors.forename: John
authors.initials: J
authors.lastname: Bucuvalas
authors.forename: Estella
authors.initials: E
authors.lastname: Alonso
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sokol
authors.forename: Michael R
authors.initials: MR
authors.lastname: Narkewicz
authors.forename: Anil
authors.initials: A
authors.lastname: Dhawan
authors.forename: Philip
authors.initials: P
authors.lastname: Rosenthal
authors.forename: Norberto
authors.initials: N
authors.lastname: Rodriguez-Baez
authors.forename: Karen F
authors.initials: KF
authors.lastname: Murray
authors.forename: Simon
authors.initials: S
authors.lastname: Horslen
authors.forename: Martin G
authors.initials: MG
authors.lastname: Martin
authors.forename: M James
authors.initials: MJ
authors.lastname: Lopez
authors.forename: Humberto
authors.initials: H
authors.lastname: Soriano
authors.forename: Brendan M
authors.initials: BM
authors.lastname: McGuire
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Jonas
authors.forename: Nada
authors.initials: N
authors.lastname: Yazigi
authors.forename: Ross W
authors.initials: RW
authors.lastname: Shepherd
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schwarz
authors.forename: Steven
authors.initials: S
authors.lastname: Lobritto
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Thomas
authors.forename: Joel E
authors.initials: JE
authors.lastname: Lavine
authors.forename: Saul
authors.initials: S
authors.lastname: Karpen
authors.forename: Vicky
authors.initials: V
authors.lastname: Ng
authors.forename: Deirdre
authors.initials: D
authors.lastname: Kelly
authors.forename: Nancy
authors.initials: N
authors.lastname: Simonds
authors.forename: Linda S
authors.initials: LS
authors.lastname: Hynan
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D020380:Needs Assessment; D011237:Predictive Value of Tests; D011379:Prognosis; D006113:United Kingdom; D014481:United States / Q000453:epidemiology