title: Acute liver failure in Chinese children: a multicenter investigation.
abstract: BACKGROUND
  Currently, no documentation is available regarding Chinese children with acute liver failure (ALF). This study was undertaken to investigate etiologies and outcomes of Chinese children with ALF.
  
  
  METHODS
  We retrospectively enrolled 32 pediatric patients with ALF admitted in five hospitals in different areas of China from January 2007 to December 2012. The coagulation indices, serum creatinine, serum lactate dehydrogenase, blood ammonia and prothrombin activity were analyzed; the relationship between these indices and mortality was evaluated by multivariate analysis.
  
  
  RESULTS
  The most common causes of Chinese children with ALF were indeterminate etiology (15/32), drug toxicity (8/32), and acute cytomegalovirus hepatitis (6/32). Only 1 patient (3.13%) received liver transplantation and the spontaneous mortality of Chinese children with ALF was 58.06% (18/31). Patients who eventually died had higher baseline levels of international normalized ratio (P=0.01), serum creatinine (P=0.04), serum lactate dehydrogenase (P=0.01), blood ammonia (P<0.01) and lower prothrombin activity (P=0.01) than those who survived. Multivariate analysis showed that the entry blood ammonia was the only independent factor significantly associated with mortality (odds ratio=1.069, 95% confidence interval 1.023-1.117, P<0.01) and it had a sensitivity of 94.74%, a specificity of 84.62% and an accuracy of 90.63% for predicting the death. Based on the established model, with an increase of blood ammonia level, the risk of mortality would increase by 6.9%.
  
  
  CONCLUSIONS
  The indeterminate causes predominated in the etiologies of ALF in Chinese children. The spontaneous mortality of pediatric patients with ALF was high, whereas the proportion of patients undergoing liver transplantation was significantly low. Entry blood ammonia was a reliable predictor for the death of pediatric patients with ALF.
authors.affiliation: Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), Beijing 100039, China. doczhaopan@126.com.
authors.forename: Pan
authors.initials: P
authors.lastname: Zhao
authors.forename: Chun-Ya
authors.initials: CY
authors.lastname: Wang
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Liu
authors.forename: Xi
authors.initials: X
authors.lastname: Wang
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Yu
authors.forename: Yan-Rong
authors.initials: YR
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000641:Ammonia / Q000097:blood; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019934:International Normalized Ratio; D007770:L-Lactate Dehydrogenase / Q000097:blood; D017114:Liver Failure, Acute / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000641:Ammonia; D003404:Creatinine; D007770:L-Lactate Dehydrogenase