title: Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013.
abstract: Data were collected of children admitted with ALF to 16 US pediatric liver transplant centers from 2008 to 2013 using the PHIS for a retrospective analysis of PALF trends. Patient data linked to the principal diagnosis code for acute necrosis of the liver (570.00) were analyzed for the following: demographics, regional differences, changes over time, pharmaceutical trends, procedural trends, associated diagnoses, and patient outcomes. In 52.5% of 583 patients who met the selection criteria for PALF, the etiology remained undetermined. Acetaminophen toxicity (18.7%) was the most common identifiable etiology, and hepatic encephalopathy (38.6%) was the most common complication. Mortality was lower than previously reported; 95.4% survived and 73.2% survived without a liver transplant. Acute respiratory failure (OR = 3.4, p = 0.035), acute kidney injury (OR = 3.6, p = 0.003), and cerebral edema (OR = 3.6, p = 0.02) were independently associated with increased risk of mortality. The use of N-acetylcysteine in non-acetaminophen-related ALF, the use of intracranial pressure monitoring, and the proportion of sepsis decreased significantly during the study period. The PHIS database can be a useful tool to study the future trends of PALF patients.
authors.affiliation: Department of Medical Education, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Sakil
authors.initials: S
authors.lastname: Kulkarni
authors.affiliation: Department of Medical Education, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Perez
authors.affiliation: Department of Medical Education, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Caren
authors.initials: C
authors.lastname: Pichardo
authors.affiliation: Department of Medical Education, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Castillo
authors.affiliation: Department of Quality and Safety, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gagnon
authors.affiliation: Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Beck-Sague
authors.affiliation: Department of Medical Education, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Rani
authors.initials: R
authors.lastname: Gereige
authors.affiliation: Department of Pediatric Gastroenterology, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Erick
authors.initials: E
authors.lastname: Hernandez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Pediatric Health Information System; acetaminophen; acute liver failure; hepatic encephalopathy; liver transplant; trends