Admission Characteristics Identify Risk of Pediatric Acute-on-Chronic Liver Failure.
J Pediatr Gastroenterol Nutr
; 70(6): 783-788, 2020 06.
Article
em En
| MEDLINE
| ID: mdl-32141996
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 4.0â±â5.6 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, 13.1â±â1.2 days versus 0.6â±â0.6 days (Pâ<â0.001) and length of stay, 24.3â±â5.0 days versus 7.9â±â1.9 days (Pâ=â0.003) 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 (Pâ<â0.0001), increased aspartate aminotransferase (AST) (Pâ=â0.014), increased international normalized ration (INR) (Pâ=â0.0015), and a positive blood culture (Pâ=â0.007).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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Admissão do Paciente
/
Insuficiência Respiratória
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Atresia Biliar
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Doença Hepática Terminal
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Insuficiência Hepática Crônica Agudizada
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Fígado
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Child
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Child, preschool
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Female
/
Humans
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Infant
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Male
Idioma:
En
Revista:
J Pediatr Gastroenterol Nutr
Ano de publicação:
2020
Tipo de documento:
Article