Indian J Pediatr (May 2014) 81(5):501–503 DOI 10.1007/s12098-013-1262-x
CLINICAL BRIEF
Can Experience from Adults Regarding Acute Liver Failure Fit Children? Pan Zhao & Chunya Wang & Weiwei Liu
Received: 28 June 2013 / Accepted: 25 September 2013 / Published online: 18 October 2013 # Dr. K C Chaudhuri Foundation 2013
Abstract Till date, comparison of clinical characteristics in acute liver failure (ALF) between adults and children has not been performed. In this study, authors retrospectively collected data on adult acute liver failure (AALF) and pediatric acute liver failure (PALF) in seven hospitals in different areas of China from January 2007 through December 2012. A total of 177 AALF cases and 32 PALF cases were eventually included. Several vital clinical variables were significantly different between AALF and PALF, including serum alkaline phosphatase, serum creatinine, serum urea nitrogen, serum lactate dehydrogenase, platelet count, prothrombin activity, international normalized ratio and blood ammonia. It is concluded that experience from AALF could not be proper for PALF. Keywords Acute liver failure . Adult . Child
Introduction The clinical course of acute liver failure (ALF) is variable and the outcome varies markedly [1]. Previous studies have shown that the etiologic spectrum and the outcome in adult acute liver failure (AALF) differed from that in pediatric acute liver failure (PALF) [2]. Additionally, definitions of AALF include P. Zhao (*) Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), No.100 of West Fourth Ring Middle Road, Beijing 100039, China e-mail: [email protected] C. Wang Emergency Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China W. Liu Postgraduate Division, Academy of Military Medical Science, Beijing, China
the presence of hepatic encephalopathy (HE), while it may not be essential to the diagnosis of PALF [3]. In recent years, considerable progress has been made in ALF, but clinical studies have mainly concerned adult patients [4]. Therefore, it is necessary to compare the clinical characteristics between AALF and PALF so that more knowledge on ALF can be gained. In this study, authors collected data on AALF and PALF from the beginning of 2007 and aimed to study the difference of clinical features between them.
Material and Methods AALF in this study was defined as coagulopathy [prothrombin activity (PTA) ≤40 % or international normalized ratio (INR) ≥1.5], jaundice [serum total bilirubin (TBil) ≥171 μmol/L] and encephalopathy (any degree of altered mentation) within 4 wk in a patient (> 12-y-old) without pre-existing liver diseases. In children, HE was often subtle, and accordingly, modified criteria for ALF were used: coagulopathy (PTA ≤ 40 % or INR ≥ 1.5) and jaundice (TBil ≥171 μmol/L) within 4 wk in a child (≤12-y-old) without pre-existing liver diseases. Seven tertiary military hospitals in different areas of China were included: Beijing 302 Hospital, General Hospital of PLA, Changhai Hospital Affiliated to Second Military Medical University, PLA 161 Hospital, PLA 477 Hospital, General Hospital of Jinan Military Region and General Hospital of Lanzhou Military Region. No cases with PALF were reported from PLA 477 Hospital and PLA 161 Hospital. The study was approved by the ethics committees of each hospital. Data analyses were performed using SAS 9.2 software (SAS Institute Inc., Cary, NC, USA). Comparisons were performed using the two-way analysis of variance. In this study, the difference based on different population (adults vs. children) was one of the main effects, and the other was
502
the different outcomes (survival vs. death). A probability (P) value of less than 0.05 was considered statistically significant.
Results As for the baseline clinical characteristics on admission, the median levels of serum alkaline phosphatase (328 U/L vs. 164 U/L, P
CLINICAL BRIEF
Can Experience from Adults Regarding Acute Liver Failure Fit Children? Pan Zhao & Chunya Wang & Weiwei Liu
Received: 28 June 2013 / Accepted: 25 September 2013 / Published online: 18 October 2013 # Dr. K C Chaudhuri Foundation 2013
Abstract Till date, comparison of clinical characteristics in acute liver failure (ALF) between adults and children has not been performed. In this study, authors retrospectively collected data on adult acute liver failure (AALF) and pediatric acute liver failure (PALF) in seven hospitals in different areas of China from January 2007 through December 2012. A total of 177 AALF cases and 32 PALF cases were eventually included. Several vital clinical variables were significantly different between AALF and PALF, including serum alkaline phosphatase, serum creatinine, serum urea nitrogen, serum lactate dehydrogenase, platelet count, prothrombin activity, international normalized ratio and blood ammonia. It is concluded that experience from AALF could not be proper for PALF. Keywords Acute liver failure . Adult . Child
Introduction The clinical course of acute liver failure (ALF) is variable and the outcome varies markedly [1]. Previous studies have shown that the etiologic spectrum and the outcome in adult acute liver failure (AALF) differed from that in pediatric acute liver failure (PALF) [2]. Additionally, definitions of AALF include P. Zhao (*) Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), No.100 of West Fourth Ring Middle Road, Beijing 100039, China e-mail: [email protected] C. Wang Emergency Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China W. Liu Postgraduate Division, Academy of Military Medical Science, Beijing, China
the presence of hepatic encephalopathy (HE), while it may not be essential to the diagnosis of PALF [3]. In recent years, considerable progress has been made in ALF, but clinical studies have mainly concerned adult patients [4]. Therefore, it is necessary to compare the clinical characteristics between AALF and PALF so that more knowledge on ALF can be gained. In this study, authors collected data on AALF and PALF from the beginning of 2007 and aimed to study the difference of clinical features between them.
Material and Methods AALF in this study was defined as coagulopathy [prothrombin activity (PTA) ≤40 % or international normalized ratio (INR) ≥1.5], jaundice [serum total bilirubin (TBil) ≥171 μmol/L] and encephalopathy (any degree of altered mentation) within 4 wk in a patient (> 12-y-old) without pre-existing liver diseases. In children, HE was often subtle, and accordingly, modified criteria for ALF were used: coagulopathy (PTA ≤ 40 % or INR ≥ 1.5) and jaundice (TBil ≥171 μmol/L) within 4 wk in a child (≤12-y-old) without pre-existing liver diseases. Seven tertiary military hospitals in different areas of China were included: Beijing 302 Hospital, General Hospital of PLA, Changhai Hospital Affiliated to Second Military Medical University, PLA 161 Hospital, PLA 477 Hospital, General Hospital of Jinan Military Region and General Hospital of Lanzhou Military Region. No cases with PALF were reported from PLA 477 Hospital and PLA 161 Hospital. The study was approved by the ethics committees of each hospital. Data analyses were performed using SAS 9.2 software (SAS Institute Inc., Cary, NC, USA). Comparisons were performed using the two-way analysis of variance. In this study, the difference based on different population (adults vs. children) was one of the main effects, and the other was
502
the different outcomes (survival vs. death). A probability (P) value of less than 0.05 was considered statistically significant.
Results As for the baseline clinical characteristics on admission, the median levels of serum alkaline phosphatase (328 U/L vs. 164 U/L, P
