title: [Aetiology, outcomes and prognostic indicators of paediatric acute liver failure].
abstract: BACKGROUND
  Acute liver failure (ALF) is a multisystem disease with severe impairment of liver function of acute onset. The Paediatric End-stage Liver Disease (PELD) score is used as a predictor of mortality in chronic liver disease, however experience is limited in ALF.
  
  
  OBJECTIVE
  To evaluate the aetiology and outcomes of children with ALF in a Children's Liver Transplant Centre, and to investigate the validity of PELD as a prognostic indicator.
  
  
  METHODS
  A retrospective study was conducted on patients diagnosed with ALF in our hospital from 2000 to 2013 using the criteria of the Paediatric ALF Study Group.
  
  
  RESULTS
  The study included 49 patients with an age range 0-14years. The most frequent aetiologies were: indeterminate (36.7%) and metabolic (26.5%). Liver transplant (LT) was required by 42.8%, and there were 16.3% deaths. Patients with higher levels of bilirubin, INR, or encephalopathy were more likely to require a liver transplant, yielding an OR for INR 1.93. A cut-off of 27 in the PELD score according to the ROC curve showed a sensitivity of 86% and a specificity of 85%, predicting a worse outcome (AUC: 0.90; P<.001). The survival of patients with ALF without transplantation seems more likely in those who have low values of PELD and absence of encephalopathy, with a RR of 0.326.
  
  
  CONCLUSIONS
  ALF patients with a high PELD score and the presence of encephalopathy had worse outcomes. The PELD score could be a useful tool to establish the optimum time for inclusion in the transplant list, however further studies are still needed.
authors.affiliation: Unidad de Gastroenterología, Hepatología, Nutrición y Trasplante Hepático Pediátrico, Unidad de Gestión Clínica, Críticos y Urgencias Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gilbert Pérez
authors.affiliation: Unidad de Gastroenterología, Hepatología, Nutrición y Trasplante Hepático Pediátrico, Unidad de Gestión Clínica, Críticos y Urgencias Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España. Electronic address: belenjordano@gmail.com.
authors.forename: Belén
authors.initials: B
authors.lastname: Jordano Moreno
authors.affiliation: Unidad de Gastroenterología, Hepatología, Nutrición y Trasplante Hepático Pediátrico, Unidad de Gestión Clínica, Críticos y Urgencias Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Mónica
authors.initials: M
authors.lastname: Rodríguez Salas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acute liver failure; Children; Fallo hepático agudo; Niños; PELD