Lee et al identified factors predictive of a poor outcome in a pediatric patient with fulminant hepatic failure. The presence of these risk factors can identify a child who should be transferred to a transplant center for evaluation. The authors are from the University of Malaya and Birmingham Children's Hospital.
Patient selection: fulminant hepatic failure
Outcome: liver transplantation or death
Patients with autoimmune hepatitis, acetaminophen overdose and hepatitis A tended to have a better survival with supportive management.
Criteria for fulminant hepatic failure:
(1) INR > 2.0 or PT > 24 seconds (coagulopathy)
(2) with or without hepatic encephalopathy
(3) less than 8 weeks since the onset of symptoms
Predictors of need for liver transplantation:
(1) severe coagulopathy (PT > 55 seconds)
(2) low serum ALT on admission (<= 2384 IU/L)
(3) prolonged duration of illness before onset of hepatic encephalopathy (> 7 days)
The combination of rising serum bilirubin and falling transaminases is a poor prognostic indicator.
The risk of a poor outcome increases with the number of predictors present.
