Prognostic parameters of pediatric acute liver failure and the role of plasma exchange.

Abstract

BACKGROUND:

This study investigated the prognostic parameters and beneficial effects of repeat plasma exchange in children with acute liver failure (ALF).

METHODS:

Twenty-three patients under 18 years of age admitted to National Taiwan University Hospital due to ALF from 2003 to 2016 were included in this retrospective analysis.

RESULTS:

Among the patients, 11 (48%) had native liver recovery (NLR), 9 (39.1%) died without liver transplant, and 3 (12.9%) received liver transplantation. The NLR group showed a lower proportion of idiopathic cases, lower peak ammonia level, higher peak alpha fetoprotein (AFP) level, and they had plasma exchange fewer times than the other groups. Receiver operating characteristic curve analyses yielded optimal cutoff values of plasma exchange (≤6 times), peak ammonia level (<190 μmol/L), and peak AFP level for predicting NLR in children with ALF.

CONCLUSION:

Pediatric ALF with idiopathic etiology, high peak ammonia level, and low peak AFP level are associated with fewer cases of NLR. Plasma exchange for more than six times probably offers little benefit with regard to patient survival if liver transplantation is not performed promptly.

• Authors: Mu-Ming Chien, Mei-Hwei Chang, Kai-Chi Chang, Fang-Ting Lu, Yu-Chun Chiu, Huey-Ling Chen, Yen-Hsuan Ni, Hong-Yuan Hsu, Jia-Feng Wu
• Journal: Pediatrics and neonatology (Pediatr Neonatol) Vol. 60 Issue 4 Pg. 389-395 (08 2019) ISSN: 2212-1692 [Electronic] Singapore
• PMID: 30361144 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018. Published by Elsevier B.V.

Chemical References

• AFP protein, human
• Antithyroid Agents
• alpha-Fetoproteins
• Propylthiouracil
• Ammonia

Topics

• Adolescent
• Ammonia (metabolism)
• Antithyroid Agents (toxicity)
• Chemical and Drug Induced Liver Injury (complications)
• Child
• Child, Preschool
• Female
• Hemochromatosis (complications)
• Hepatitis, Viral, Human (complications)
• Hepatolenticular Degeneration (complications)
• Humans
• Infant
• Infant, Newborn
• Liver Failure, Acute (etiology, metabolism, therapy)
• Liver Transplantation
• Lymphohistiocytosis, Hemophagocytic (complications)
• Male
• Metabolism, Inborn Errors (complications)
• Mortality
• Plasma Exchange
• Prognosis
• Propylthiouracil (toxicity)
• ROC Curve
• Recovery of Function
• Retrospective Studies
• Taiwan
• alpha-Fetoproteins (metabolism)