title: EEG abnormalities are associated with increased risk of transplant or poor outcome in children with acute liver failure.
abstract: OBJECTIVE
  There are limited data on the incidence of seizures and utility of brain imaging and electroencephalogram (EEG) to predict outcome of children with acute liver failure (ALF). We investigated the association between hepatic encephalopathy (HE) scores, abnormal EEG or neuroimaging, and short-term outcome.
  
  
  METHODS
  Single-center retrospective observational study of infants and children with ALF who underwent continuous EEG monitoring and brain imaging within 24 hours of admission to the intensive care unit (ICU).
  
  
  RESULTS
  A total of 19 patients with ALF with a mean age of 6.8 ± 1.5 years were evaluated. The majority of cases (74%) were indeterminate. Of the total, 10 patients (53%) survived to discharge without liver transplant (LT), 5 (26%) received LT, and 4 (21%) died without LT. Seizures occurred in only 2 cases (19%). Patients who had an abnormal EEG on admission (n = 7) were significantly more likely to die or require LT (P < 0.05, Fisher exact test). Patients with either an admission HE score ≤ 2, or liver injury unit score <222, combined with a normal or mildly abnormal EEG were more likely to survive without LT. Neuroimaging was normal in the majority of cases (87%) and was not associated with outcome.
  
  
  CONCLUSIONS
  Children with a moderate or severe abnormality of EEG background on admission were significantly more likely to require LT or to die. Children with an HE score ≤ 2, and a normal or only mildly abnormal EEG, were significantly more likely to survive without needing LT. These findings are an initial step toward distinguishing patients with ALF who may recover spontaneously from those who will require LT.
authors.affiliation: *Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program †Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL.
authors.forename: Elora
authors.initials: E
authors.lastname: Hussain
authors.forename: Michele
authors.initials: M
authors.lastname: Grimason
authors.forename: Joshua
authors.initials: J
authors.lastname: Goldstein
authors.forename: Craig M
authors.initials: CM
authors.lastname: Smith
authors.forename: Estella
authors.initials: E
authors.lastname: Alonso
authors.forename: Peter F
authors.initials: PF
authors.lastname: Whitington
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D019344:Lactic Acid / Q000097:blood; D017114:Liver Failure, Acute / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D019344:Lactic Acid; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase