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| Acute liver failure in Chinese children: a multicenter investigation |
| Pan Zhao, Chun-Ya Wang, Wei-Wei Liu, Xi Wang, Li-Ming Yu and Yan-Rong Sun |
Beijing, China
Author Affiliations: Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), Beijing 100039, China (Zhao P); Emergency Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; Intensive Care Unit, Emergency Department, General Hospital of PLA, Beijing 100853, China (Wang CY); Postgraduate Division, Academy of Military Medical Science, Beijing 100850, China (Liu WW); Medical Administration Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China (Wang X); Medical Administration Department, General Hospital of Jinan Military Region, Jinan 250000, China (Yu LM); Medical Administration Department, General Hospital of Lanzhou Military Region, Lanzhou 730050, China (Sun YR)
Corresponding Author: Pan Zhao, MD, Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), No. 100 of West Fourth Ring Middle Road, Beijing 100039, China (Tel/Fax: 86-10- 66933020; Email: doczhaopan@126.com) |
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Abstract BACKGROUND: Currently, no documentation is available regarding Chinese children with acute liver failure (ALF). This study was undertaken to investigate etiologies and outcomes of Chinese children with ALF.
METHODS: We retrospectively enrolled 32 pediatric patients with ALF admitted in five hospitals in different areas of China from January 2007 to December 2012. The coagulation indices, serum creatinine, serum lactate dehydrogenase, blood ammonia and prothrombin activity were analyzed; the relationship between these indices and mortality was evaluated by multivariate analysis.
RESULTS: The most common causes of Chinese children with ALF were indeterminate etiology (15/32), drug toxicity (8/32), and acute cytomegalovirus hepatitis (6/32). Only 1 patient (3.13%) received liver transplantation and the spontaneous mortality of Chinese children with ALF was 58.06% (18/31). Patients who eventually died had higher baseline levels of international normalized ratio (P=0.01), serum creatinine (P=0.04), serum lactate dehydrogenase (P=0.01), blood ammonia (P<0.01) and lower prothrombin activity (P=0.01) than those who survived. Multivariate analysis showed that the entry blood ammonia was the only independent factor significantly associated with mortality (odds ratio=1.069, 95% confidence interval 1.023-1.117, P<0.01) and it had a sensitivity of 94.74%, a specificity of 84.62% and an accuracy of 90.63% for predicting the death. Based on the established model, with an increase of blood ammonia level, the risk of mortality would increase by 6.9%.
CONCLUSIONS: The indeterminate causes predominated in the etiologies of ALF in Chinese children. The spontaneous mortality of pediatric patients with ALF was high, whereas the proportion of patients undergoing liver transplantation was significantly low. Entry blood ammonia was a reliable predictor for the death of pediatric patients with ALF.
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2014, Vol. 13 
