The Importance of Early Referral in Pediatric Acute Liver Failure

Authors

  • Mónica Jerónimo Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
  • Rita Moinho Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
  • Carla Pinto Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
  • Leonor Carvalho Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
  • Isabel Gonçalves Unidade de Transplantação Hepática Pediátrica e de Adultos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
  • Emanuel Furtado Unidade de Transplantação Hepática Pediátrica e de Adultos. Centro Hospitalar e Universitário de Coimbra. Coimbra, Portugal.
  • José Farela Neves Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.

DOI:

https://doi.org/10.20344/amp.6195

Keywords:

Child, Liver Failure, Acute, Liver Transplantation, Referral and Consultation.

Abstract

Introduction: Acute liver failure is a rare disorder associated to high morbidity and mortality despite survival improvement through liver transplantation. The importance of a multidisciplinary approach and early referral to a pediatric liver transplantation center were important conclusions of a national meeting in 2008, from which resulted an actuation consensus.
Objectives: To characterize acute liver failure admissions in a Pediatric Intensive Care Unit of the portuguese pediatric liver
transplantation center. To compare results before (A) and after (B) 2008.
Material and Methods: Observational, retrospective study during a 20 year period (1994-2014). Inclusion criteria: age < 18 years old and acute liver failure (INR ≥ 2 without vitamin K response and hepatocellular necrosis). Children with previous liver disease were excluded.
Results: Fifty children were included, with median age of 24.5 months. The most common etiology under 2 years old was metabolic (34.6%) and above that age was infectious (29.2%). Forty six percent were submitted to liver transplantation and 78% of them survived. Overall mortality was 34%. Median referral time was 7 days in period A (n = 35) and 2 days in period B (n = 15; p = 0.006). Pediatric risk of mortality´s median was 14.7 in period A and 6.5 in B (p = 0.019). Mortality was 37% vs 26% in periods A and B, respectively (p = 0.474).
Discussion and Conclusions: Overall mortality was similar to the observed in other European centers. Liver transplantation is in fact the most effective therapeutic option. After 2008, there was a reduction in referral time and cases severity on admission; however, mortality has not reduced so far.

Downloads

Download data is not yet available.

Published

2015-09-11

How to Cite

1.
Jerónimo M, Moinho R, Pinto C, Carvalho L, Gonçalves I, Furtado E, Farela Neves J. The Importance of Early Referral in Pediatric Acute Liver Failure. Acta Med Port [Internet]. 2015 Sep. 11 [cited 2023 Feb. 7];28(5):559-66. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6195