Acute liver failure in children: 20-year experience.
OBJECTIVE
We aimed to determine the causes, demographic findings, clinical status, outcomes, and prognostic risk factors of patients with acute liver failure admitted to Hacettepe University Children's Hospital between October 1987-October 2006.


METHODS
This retrospective case study included 74 patients with acute liver failure according to the Pediatric Acute Liver Failure Study Group definition.


RESULTS
The etiology of acute liver failure was metabolic in 26 (35.1%) and infectious in 21 (28.4%) patients. Sixteen (21.6%) patients had indeterminate causes. Wilson's disease (16/26 patients, 61.5%) was the most frequent metabolic disease, while hepatitis A (14/21 patients, 66.7%) was the most frequent infectious agent. Neurologic functions were normal in 21 (28.4%) patients. Forty-nine (66.2%) patients died and 24 (32.4%) recovered. Two patients underwent liver transplantation. The mortality rate was 82.9% for patients who were not transplanted but fulfilled King's College Hospital criteria and 45.4% for patients who were not suitable for transplantation. This difference was statistically significant (p=0.001). Total bilirubin >5.35 mg/dl, international normalized ratio (INR) >3.66 and prothrombin time >23.5 seconds were shown to be the risk factors to predict death.


CONCLUSIONS
Metabolic and infectious etiologies were responsible for most of the acute liver failure cases. Clinical encephalopathy may not be present in children.
Gazi University Hospital, Pediatric Gastroenterology, Ankara, Turkey. zeren_baris@yahoo.com
Zeren
Z
Bariş
Inci Nur
IN
Saltik Temızel
Nuray
N
Uslu
Yusuf
Y
Usta
Hülya
H
Demır
Figen
F
Gürakan
Hasan
H
Ozen
Aysel
A
Yüce
D000293:Adolescent; D001201:Ascites / Q000453:epidemiology / Q000209:etiology; D001663:Bilirubin / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D004487:Edema / Q000453:epidemiology / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006506:Hepatitis A / Q000150:complications / Q000453:epidemiology; D006527:Hepatolenticular Degeneration / Q000150:complications / Q000453:epidemiology; D006529:Hepatomegaly / Q000453:epidemiology / Q000209:etiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019934:International Normalized Ratio; D007565:Jaundice / Q000453:epidemiology / Q000209:etiology; D017114:Liver Failure, Acute / Q000209:etiology* / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D013163:Splenomegaly / Q000453:epidemiology / Q000209:etiology; D014421:Turkey / Q000453:epidemiology
D001663:Bilirubin