title: [The Importance of Early Referral in Pediatric Acute Liver Failure].
abstract: BACKGROUND
  Acute liver failure is a rare disorder associated to high morbidity and mortality despite survival improvement through liver transplantation. The importance of a multidisciplinary approach and early referral to a pediatric liver transplantation center were important conclusions of a national meeting in 2008, from which resulted an actuation consensus.
  
  
  OBJECTIVE
  To characterize acute liver failure admissions in a Pediatric Intensive Care Unit of the portuguese pediatric livertransplantation center. To compare results before (A) and after (B) 2008.
  
  
  METHODS
  Observational, retrospective study during a 20 year period (1994-2014).
  
  
  METHODS
  age < 18 years old and acute liver failure (INR ≥ 2 without vitamin K response and hepatocellular necrosis). Children with previous liver disease were excluded.
  
  
  RESULTS
  Fifty children were included, with median age of 24.5 months. The most common etiology under 2 years old was metabolic (34.6%) and above that age was infectious (29.2%). Forty six percent were submitted to liver transplantation and 78% of them survived. Overall mortality was 34%. Median referral time was 7 days in period A (n = 35) and 2 days in period B (n = 15; p = 0.006). Pediatric risk of mortality's median was 14.7 in period A and 6.5 in B (p = 0.019). Mortality was 37% vs 26% in periods A and B, respectively (p = 0.474).
  
  
  CONCLUSIONS
  Overall mortality was similar to the observed in other European centers. Liver transplantation is in fact the most effective therapeutic option. After 2008, there was a reduction in referral time and cases severity on admission; however, mortality has not reduced so far.
authors.affiliation: Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
authors.forename: Mónica
authors.initials: M
authors.lastname: Jerónimo
authors.affiliation: Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Moinho
authors.affiliation: Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Pinto
authors.affiliation: Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
authors.forename: Leonor
authors.initials: L
authors.lastname: Carvalho
authors.affiliation: Unidade de Transplantação Hepática Pediátrica e de Adultos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Gonçalves
authors.affiliation: Unidade de Transplantação Hepática Pediátrica e de Adultos. Centro Hospitalar e Universitário de Coimbra. Coimbra, Portugal.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Furtado
authors.affiliation: Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Farela Neves
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D017114:Liver Failure, Acute / Q000209:etiology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies