title: Etiology, outcome and prognostic factors of childhood acute liver failure in a German Single Center.
abstract: Pediatric acute liver failure (PALF) is a progressive, potentially fatal clinical syndrome occurring in previously healthy children. Our study aimed to determine the current leading causes of PALF in a single center in Germany, identifying possible prognostic markers. Thirty-seven pediatric patients with PALF were included. Medical records were reviewed for demographic, laboratory and clinical data. Laboratory results on admission and at peak value, PELD and MELD score on admission, and intensive care support were assessed. Fifteen patients recovered spontaneously, 14 died without transplantation, and 8 received a liver transplant. Patients who survived were significantly older than patients who died. Specific causes of PALF could be identified as infectious diseases (16%), metabolic diseases (14%), toxic liver injury (11%), immunologic diseases (8%), or vascular diseases (8%). Causes of PALF remained indeterminate in 43%. High ammonia, low albumin, and low ALT levels on admission were associated with worse outcome. Absence of need of ventilation, hemodialysis, and circulatory support predicted spontaneous recovery. In conclusion, infections are the most common known cause of PALF. However, in a large proportion of patients the cause for PALF remains cryptic. Ammonia and albumin levels may be of prognostic value to predict outcomes.
authors.affiliation: Department of Pediatrics II, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Kathemann
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Lars P
authors.initials: LP
authors.lastname: Bechmann
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Sowa
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Manka
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dechêne
authors.affiliation: Department of Pediatrics II, University Hospital, University.
authors.forename: Patrick
authors.initials: P
authors.lastname: Gerner
authors.affiliation: Department of Pediatrics II, University Hospital, University.
authors.forename: Elke
authors.initials: E
authors.lastname: Lainka
authors.affiliation: Department of Pediatrics II, University Hospital, University.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Hoyer
authors.affiliation: Department of Pediatrics, University of California San Diego (UCSD), CA, USA.
authors.forename: Ariel E
authors.initials: AE
authors.lastname: Feldstein
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000641:Ammonia / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017114:Liver Failure, Acute / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D000641:Ammonia; D003404:Creatinine; D001219:Aspartate Aminotransferases; D000075462:Serum Albumin, Human