Etiology and Outcome of Acute Liver Failure in Children—The Experience of a Single Tertiary Care Hospital from Romania

Alina Grama,Cornel Olimpiu Aldea,Emanuela Duca,Claudia Sirbe,Dan Delean,Bogdan Bulata,Dora Boghitoiu,Lucia Burac,Tudor Lucian Pop,Alexandra Coroleuca

doi:10.3390/children7120282

Abstract

Background: Acute liver failure (ALF) is a rare disease, associated with high mortality, despite optimal medical therapy without emergency liver transplantation. Knowing the possible cause of ALF plays a vital role in the management, as the child could benefit from effective specific therapies in emergencies. Methods: We have analyzed the etiology and outcome of ALF in children followed-up in a tertiary care hospital between January 2012–December 2018. The patients were grouped into different age categories: neonates (0–1 month), infants (1–12 months), children (1–14 years), and teenagers (14–18 years). Results: 97 children (46 males, 47.42%, the mean age of 7.66 ± 8.18 years) were admitted with ALF. The most important causes of ALF were in neonates and infants, infections (72.72%), and metabolic disorders (43.47%), in children and adolescents were the toxic causes (60% and 79.41%). The mortality rate was 31.95% (31 patients), mainly in ALF due to infections or metabolic disorders. Conclusions: In neonates and infants, the main causes of ALF were infections and metabolic diseases, while in older children and teenagers, were toxin-induced liver injuries. The mortality among neonates and infants was significantly higher than in other ages. Early recognition and immediate therapeutic intervention could improve the outcome of these patients.

Highlights

Acute liver failure (ALF) is a rare condition in pediatric pathology, with increased mortality (50%) despite optimal medical therapy in the absence of emergency liver transplantation [1,2,3]
We have included in the cohort 97 children (1–18 years) who met the Pediatric Acute Liver Failure (PALF) criteria for ALF, respectively patients without pre-existing liver disease who presented uncorrectable coagulopathy with
We analyzed the etiology of ALF by four age categories: neonates (0–1 month), infants (1–12 months), children (1–14 years) and teenagers (14–18 years)

Summary

Introduction

Acute liver failure (ALF) is a rare condition in pediatric pathology, with increased mortality (50%) despite optimal medical therapy in the absence of emergency liver transplantation [1,2,3]. The causes of ALF in children are different from those of the adult and vary according to the age of the child. This is due to age, limited defense resources, immaturity. Acute liver failure (ALF) is a rare disease, associated with high mortality, despite optimal medical therapy without emergency liver transplantation. The most important causes of ALF were in neonates and infants, infections (72.72%), and metabolic disorders (43.47%), in children and adolescents were the toxic causes

Methods

Results

Discussion

Conclusion