Characterization of acute liver failure and development of a continuous risk of death staging system in children

J Hepatol. 2006 Jan;44(1):134-41. doi: 10.1016/j.jhep.2005.06.021. Epub 2005 Jul 18.


Background/aims: Acute liver failure (ALF) in children has been associated with an overall mortality of approximately 70% in the pretransplant era and 50-80% survival in those undergoing orthotopic liver transplantation. There is currently no system for staging severity of ALF in children. The aim of this study was to characterize pediatric ALF in a tertiary hospital and to derive a scoring system to stratify severity of ALF based on predicted mortality.

Methods: Prospective data collection of 81 children from December 1993-2003 who presented with ALF. Data recorded included peak laboratory values, clinical characteristics, and survival.

Results: Transplant-free survival was 56% with overall survival including those undergoing OLT of 72%. Transplantation rate was 22% with transplant survival of 72%. Of the peak laboratory values analyzed, total bilirubin, prothrombin time/INR, and ammonia were the most predictive of death or a need for liver transplant. A simple risk staging system was developed based on the ability of these three laboratory measurements to predict mortality.

Conclusions: The survival in pediatric ALF has improved in recent years. Risk staging for ALF could potentially be used in clinical research for risk-adjusted outcomes analysis and to help stratify patients for clinical studies according to mortality risk.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ammonia / blood
  • Bilirubin / blood
  • Biomarkers / blood
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Liver Failure, Acute / blood
  • Liver Failure, Acute / classification
  • Liver Failure, Acute / mortality*
  • Male
  • Prognosis
  • Prospective Studies
  • Prothrombin Time
  • Risk Assessment / classification
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate


  • Biomarkers
  • Ammonia
  • Bilirubin