title: [Clinical application of blood purification (artificial liver) in treatment of acute liver failure in children].
abstract: OBJECTIVE
  To investigate the clinical application, indication, timing and prognosis of blood purification (artificial liver, BP) in treatment of acute liver failure in children.
  
  
  METHODS
  Artificial liver was used to treat 30 cases of pediatric acute liver failure (PALF), who were hospitalized in pediatric intensive care unit of Bayi Children's Hospital Affiliated to Beijing Military Command General Hospital, during March 2010 to July 2013. Simple plasma exchange (PE) mode was used for PALF without complications, while PE combined with continuous veno-venous hemodiafiltration (CVVHDF) mode was used for PALF with cerebral edema and/or hepatorenal syndrome and/or serious abnormality of electrolyte and acid-base balance.
  
  
  RESULTS
  Sixteen cases survived and restored hepatic function, with a survival rate of 53.3%. Single PE therapy could significantly decrease total bilirubin (TBIL) from (293.96 ± 214.52) µmol/L to (155.64 ± 140.97) µmol/L (P = 0.033), increase prothrombin time activity (PTA) from (34.50 ± 18.34) % to (60.50 ± 33.97) % (P = 0.013), while it did not significantly influence ammonia from (156.43 ± 67.23) µmol/L to (124.03 ± 62.58) µmol/L (P = 0.156) and alanine transarninase (ALT) from (752.53 ± 1 291.84) U/L to (132.00 ± 98.57) U/L (P = 0.066). PE + CVVHDF therapy could significantly ameliorate TBIL from (326.90 ± 233.85) µmol/L to (157.53 ± 125.31) µmol/L (P = 0.033), ALT from (1 476.64 ± 1 728.18) U/L to (169.38 ± 207.18) U/L (P = 0.019), ammonia from (215.83 ± 83.92) µmol/L to (141.25 ± 63.09) µmol/L (P = 0.022) and PTA from (36.68 ± 23.13)% to (71.75 ± 50.50) % (P = 0.044). Prothrombin time (PT) from (29.71 ± 17.75)s to (16.27 ± 6.38)s (P = 0.008) , ALT from (1 574.11 ± 1 775.96) U/L to (145.81 ± 113.89 ) U/L (P = 0.003) , TBIL from (233.16 ± 219.70) µmol/L to (75.19 ± 86.07) µmol/L (P = 0.012) , ammonia from (182.75 ± 90.07) µmol/L to (101.81 ± 37.14) µmol/L (P = 0.002) and PTA from (38.38 ± 20.39)% to (83.13 ± 41.68)% (P = 0.001) in survived cases significantly ameliorated after BP therapy. TBIL from (394.04 ± 192.80) µmol/L to (249.34 ± 113.97) µmol/L (P = 0.023) in died cases declined significantly after BP therapy, while alteration of PT, ALT, ammonia , and PTA had no statistical significance (P > 0.10) after BP therapy.
  
  
  CONCLUSIONS
  PE + CVVHDF therapy could significantly ameliorate not only TBIL and PTA but also ammonia and ALT compared with single PE therapy. The decline of only an index like TBIL or ALT after BP therapy could not improve the prognosis. The inconsistency between serum bilirubin and ALT levels was an important factor that suggested poor prognosis of ALF, and it might increase survival rate to use BP therapy before that inconsistency emerged.
authors.affiliation: Center of Children's Advanced Disease, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Xu
authors.affiliation: Center of Children's Advanced Disease, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China.
authors.forename: Bang
authors.initials: B
authors.lastname: Yu
authors.affiliation: Center of Children's Advanced Disease, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhu
authors.affiliation: Center of Children's Advanced Disease, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China.
authors.forename: Haili
authors.initials: H
authors.lastname: Ren
authors.affiliation: Center of Children's Advanced Disease, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China. Email: zhjfengzc@126.com.
authors.forename: Zhichun
authors.initials: Z
authors.lastname: Feng
mesh_terms: D000293:Adolescent; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001929:Brain Edema / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006493:Heparin / Q000494:pharmacology; D006530:Hepatorenal Syndrome / Q000209:etiology / Q000628:therapy; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D010951:Plasma Exchange; D011517:Prothrombin Time; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006493:Heparin; D001663:Bilirubin