Acute-on-chronic liver failure: A 20-year retrospective review of a tertiary paediatric liver centre.
Singh, Harveen Kelgeri, Chayarani Passingham, Charlotte Johansen, Lauren van Mourik, Indra Ong, Evelyn Perera, M Thamara P R Mirza, Darius Sharif, Khalid Hartley, Jane
Singh, Harveen
Kelgeri, Chayarani
Passingham, Charlotte
Johansen, Lauren
van Mourik, Indra
Ong, Evelyn
Perera, M Thamara P R
Mirza, Darius
Sharif, Khalid
Hartley, Jane
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2022-04-21
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Abstract
Aim: Acute-on-chronic liver failure (ACLF) is an acute deterioration of pre-existing chronic liver disease related to a precipitating event. We characterised paediatric ACLF at Birmingham Children's Hospital (BCH) utilising European Association of Liver Disease CLIF criteria, including prevalence, triggers and outcomes.
Methods: All BCH patients from 2000 to 2020 with CLD who underwent initial liver transplant or died on the transplant waiting list or whilst too unwell to be listed were reviewed.
Results: From 2000 to 2020, 24 (4%) children with ACLF were identified. Death occurred in 18 (75%). Transplant occurred in 9 (36%), 3 of which died. ACLF triggers were sepsis organism negative 11 (46%), sepsis organism positive 8 (33%) and GI bleed 5 (17%). Bilirubin at the time of transplant/death in those with ACLF who lived compared with those who died was 529 umol/L (381) versus 665 (210) (p=0.38), creatinine 138 umol/L (147) versus 67 (46) (p=0.41), PT 33 sec (14) versus (32 (15) (p = 0.72), Grade 3, 4 hepatic encephalopathy 1 (17%) versus 10 (56%) (p = 0.17), vasopressor use 1 (17%) versus 17 (94%) (p = 0.001) and ventilation 3 (50%) versus 17 (94%) (p = 0.035).
Conclusion: Acute-on-chronic liver failure whilst infrequent has high rates of mortality. The use of vasopressors and ventilation is more frequent in those who die from ACLF.
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Singh H, Kelgeri C, Passingham C, Johansen L, van Mourik I, Ong E, Perera MTPR, Mirza D, Sharif K, Hartley J, Gupte GL. Acute-on-chronic liver failure: A 20-year retrospective review of a tertiary paediatric liver centre. Acta Paediatr. 2022 Jul;111(7):1435-1440. doi: 10.1111/apa.16352. Epub 2022 Apr 21.
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