Uchida et al identified predictors for liver transplantation in a pediatric patient with acute liver failure (ALF). The authors are from the National Center for Child Health and Development in Tokyo.
Patient selection: pediatric patient with acute liver failure (ALF)
Testing: days 1, 3 and 5
Parameters:
(1) JIHBDSG score (score of Naiki et al)
(2) serum alpha-fetoprotein (AFP) in ng/mL
(3) INR
The best predictor of liver transplantation was the JIHBDSG score on day 5 being > 3 (sensitivity 84% with specificity 92% and diagnostic accuracy of 83%).
Additional findings associated with liver transplantation:
(1) increasing trend in JIHBDSG
(2) nonchanging or declining serum alpha-fetoprotein
(3) INR ratio > 1.25 (ratio of INR after admission to INR on admission.
where:
• The definition of the INR ratio is unclear (see page 1244).
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