Rajanyagam et al reported prognostic factors for pediatric patients with acute liver failure (PALF). These can help to identify a patient who may have a poor outcome. The authors are from the Royal Children's Hospital, University of Queensland, and the Royal Brisbane and Women's Hospital in Australia.
Patient selection: pediatric acute liver failure (PALF), age 0 to 16 years
Criteria for PALF:
(1) pediatric age
(2) evidence of acute liver disease AND no evidence of chronic liver disease
(3) one of the following:
(3a) hepatic-based coagulopathy (INR >= 1.5) nor corrected by vitamin K AND hepatic encephalopathy
(3b) hepatic-based coagulopathy (INR >= 2) nor corrected by vitamin
PELD scores were calculated if < 12 years old and MELD if >= 12 years old.
Predictors of poor outcome (death) is not transplanted:
(1) age < 3 months
(2) body weight < 4.7 kilograms
Independent predictors of poor outcome (death or liver transplant):
(1) peak serum total bilirubin > 220 µmol/L
(2) peak INR > 4
(3) PELD or MELD score >= 27 when criteria for PALF met
(4) peak PELD or MELD >= 42
