Etiology, Outcome and Prognostic Indicators of Childhood Fulminant Hepatic Failure in the United Kingdom

• DOI: 10.1097/01.mpg.0000158524.30294.e2
• Publication Date: 2005-04-28T08:01:24Z
• Authors: Way Seah Lee; Patrick McKiernan; Deirdre Anne Kelly
• Keywords: Fulminant hepatic failure; Hepatic Encephalopathy; Autoimmune Hepatitis; Liver disease; Etiology; Prothrombin time

ABSTRACT Objective: To study the etiology, outcome and prognostic indicators in children with fulminant hepatic failure United Kingdom. Design: Retrospective review of all patients <17 years from 1991 to 2000. Fulminant was defined as presence coagulopathy (prothrombin time >24 seconds or International Normalized Ratio >2.0) without encephalopathy within 8 weeks onset symptoms. Setting: Liver Unit, Birmingham Children's Hospital, Results: Ninety‐seven (48 male, 49 female; median age, 27 months; range, 1 day‐192.0 months) were identified failure. The etiologies were: 22 metabolic, 53 infectious, 19 drug‐induced, 3 autoimmune hepatitis. overall survival rate 61%. 33% (32/97) recovered spontaneously supportive management. Fifty‐five assessed for liver transplantation. Four unstable not listed transplantation; 11 died while awaiting transplantation contraindicated 10 children. Of 40 who underwent transplantation, survived. Children hepatitis, paracetamol overdose hepatitis A more likely survive had a delay between first symptom disease (median, 10.5 days versus 3.5 days), higher plasma bilirubin (299 μmol/L 80 μmol/L), prothrombin (62 seconds) lower alanine aminotransferase (1288 IU/L 2929 IU/L) levels on admission die require ( P < 0.05). On multivariate analysis, significant independent predictors eventual conservative therapy >7 days, >55 ≤2384 admission. Conclusions: severe coagulopathy, prolonged duration illness before are Early referral specialized center consideration is vital.