title: Profile and outcome of first 109 cases of paediatric acute liver failure at a specialized paediatric liver unit in India.
abstract: The outcome of paediatric acute liver failure largely depends on age and aetiology. The aim of this work was to study the aetiological spectrum and outcome of the paediatric acute liver failure cases.
  
  
  
  This prospective observational study included all children (<18 years age) fulfilling paediatric acute liver failure study group definition. Aetiological evaluation was done and predictive factors for poor outcome (death or liver transplantation) were analysed.
  
  
  
  There were 109 children in total. The commonest aetiology was viral infections (50, 45.8%) followed by metabolic liver diseases (14, 13.2%) and drug-induced liver injury (12, 11%). Viral, indeterminate and drug-induced liver injury group were older in age, had higher international normalized ratio and alanine transaminases in comparison with those with metabolic liver diseases and other aetiologies (P<.05). At 90 days from presentation, 52 (47.7%) children survived with native liver. On multivariate analysis, jaundice to encephalopathy interval >7 days (adjusted OR: 9.16, 95% CI: 1.55-53) and higher paediatric/model for end-stage liver disease scores at 72 hours (adjusted OR: 1.2, 95% CI: 1.08-1.32) were associated with poor outcome.
  
  
  
  Viral infections, indeterminate and drug-induced liver injury-related paediatric acute liver failure usually present in older children with higher international normalized ratio and alanine transaminases. Jaundice to encephalopathy interval >7 days and paediatric/model for end stage liver disease score >24 at 72 hours are associated with poor outcome.
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Seema
authors.identifier: 0000-0003-0888-8625
authors.initials: S
authors.lastname: Alam
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Khanna
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Vikrant
authors.initials: V
authors.lastname: Sood
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Bikrant B
authors.initials: BB
authors.lastname: Lal
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Rawat
mesh_terms: D000293:Adolescent; D000367:Age Factors; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D007565:Jaundice / Q000209:etiology; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications
keywords: liver transplantation; paediatric acute liver failure; paediatric/model for end-stage liver disease score; prognosis