title: Differential clinical characteristics of acute liver failure caused by hemophagocytic lymphohistiocytosis in children.
abstract: BACKGROUND
  Children with acute liver failure (ALF) caused by hemophagocytic lymphohistiocytosis (HLH) may be at risk of undergoing unnecessary liver transplantation (LT). The aim of this study was to compare the characteristics of ALF caused by HLH with those of ALF of unknown etiology in children.
  
  
  METHODS
  The clinical features and laboratory findings for eight children with ALF caused by HLH (ALF-HLH group) and 27 children with ALF of unknown etiology (ALF-UK group) were retrospectively compared by reviewing medical records.
  
  
  RESULTS
  The ALF-HLH group had a higher incidence of pleural effusion, C-reactive protein elevation (especially >5 mg/dL), thrombocytopenia, anemia, fever, splenomegaly, and hypoalbuminemia (<2.5 mg/dL), and a higher in-hospital mortality rate. No significant differences were found in the white blood cell count, liver enzymes, coagulation profile, or incidence of hepatomegaly.
  
  
  CONCLUSIONS
  LT should be performed only after it is proven that ALF is not caused by HLH, if a child with ALF shows the differential clinical features of ALF caused by HLH. Further research with larger sample sizes, however, is needed.
authors.affiliation: Department of Pediatric Emergency Medicine, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Ryu
authors.forename: Kyung Mo
authors.initials: KM
authors.lastname: Kim
authors.forename: Seak Hee
authors.initials: SH
authors.lastname: Oh
authors.forename: Kyung Nam
authors.initials: KN
authors.lastname: Koh
authors.forename: Ho Joon
authors.initials: HJ
authors.lastname: Im
authors.forename: Chan-Jeoung
authors.initials: CJ
authors.lastname: Park
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Chi
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Seo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000209:etiology*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications*; D008297:Male; D012189:Retrospective Studies
keywords: acute liver failure; child; hemophagocytic lymphohistiocytosis; liver transplantation