Admission Characteristics Identify Risk of Pediatric Acute-on-Chronic Liver Failure. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Banc-Husu, Anna M.; Neighbors, Katie; Rychlik, Karen; Mohammad, Saeed; Harris, Zena Leah; Alonso, Estella M.
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 70:Issue 6(2020)
• Publication Date: 2020-06
• Subjects: biliary atresia -- children -- critical care -- decompensated cirrhosis; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000002695
• Languages: English
• ISSNs: 0277-2116

Abstract

ABSTRACT: Objectives: Acute-on-chronic liver failure (ACLF) is well-studied in adults and characterized by decompensated cirrhosis, multi-organ failure, and early mortality. Studies of ACLF in children are limited. We sought to characterize the prevalence and clinical factors associated with pediatric ACLF (PACLF). Methods: A retrospective review of children 3 months to 18 years listed for liver transplantation and hospitalized for decompensated cirrhosis between January 2007 and December 2017 at a single pediatric hospital. Primary outcome was the development of PACLF, characterized as failure of at least 1 extrahepatic organ (mechanical ventilation, renal replacement therapy, vasoactive medications, grade III/IV hepatic encephalopathy). Characteristics were recorded for each hospitalization. Results: Sixty-six patients had 186 hospitalizations with mean age at admission 4.0 ± 5.6 years and diagnosis of biliary atresia (BA) in 65%. PACLF developed in 20 patients during 23 hospitalizations (12%) and respiratory failure was most common (17/23, 74%). Duration of intensive care unit stay, 13.1 ± 1.2 days versus 0.6 ± 0.6 days ( P < 0.001) and length of stay, 24.3 ± 5.0 days versus 7.9 ± 1.9 days ( P = 0.003) were longer in PACLF compared with non-PACLF. Mortality during PACLF hospitalizations was 22%. Clinical factors associated with PACLF were reported from a generalized linear mixed model and included increased admission creatinine ( P < 0.0001), increased aspartate aminotransferase (AST) ( P = 0.014), increased international normalized ration (INR) ( P = 0.0015), and a positive blood culture ( P = 0.007). Conclusion: In this pediatric series, PACLF developed in 12% of hospitalizations and mortality was high. Admission creatinine, AST, INR, and presence of a positive blood culture were associated with PACLF development. Abstract : Supplemental Digital Content is available in the text