Prognostic parameters of pediatric acute liver failure and the role of plasma exchange.
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
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
acute liver failure
alpha-fetoprotein
ammonia
pediatric
plasma exchange
Journal
Pediatrics and neonatology
ISSN: 2212-1692
Titre abrégé: Pediatr Neonatol
Pays: Singapore
ID NLM: 101484755
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
01
03
2018
revised:
23
05
2018
accepted:
19
09
2018
pubmed:
27
10
2018
medline:
29
1
2020
entrez:
27
10
2018
Statut:
ppublish
Résumé
This study investigated the prognostic parameters and beneficial effects of repeat plasma exchange in children with acute liver failure (ALF). 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 30361144
pii: S1875-9572(18)30163-3
doi: 10.1016/j.pedneo.2018.09.006
pii:
doi:
Substances chimiques
AFP protein, human
0
Antithyroid Agents
0
alpha-Fetoproteins
0
Propylthiouracil
721M9407IY
Ammonia
7664-41-7
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
389-395Informations de copyright
Copyright © 2018. Published by Elsevier B.V.