Related factors of prognosis for acute liver failure in critically ill children

Objective To analyze the clinical features of acute liver failure in critically ill children, to investigate the risk factors affecting the prognosis of acute liver failure in critically ill children, and to provide evidence for clinical diagnosis and prognosis. Methods The data of 85 children with acute liver failure who conformed to the diagnostic criteria from January 2011 to January 2017 at Hunan Children′s Hospital were analyzed.According to the prognosis of children with acute liver failure, all children were divided into the survival group (49 cases) and the death group (36 cases). Univariate and multivariate Logistic regression methods were used to analyze the risk factors affecting the prognosis of children with acute liver failure. Results There were statistically significant differences of enzyme bile isolation[26.5% (13/49 cases) vs.55.6%(20/36 cases), χ2=7.361, P=0.007], hepatic encephalopathy [16.3%(8/49 cases) vs.38.9%(14/36 cases), χ2=5.507, P=0.019], total bilirubin [72.30(3.93-428.80) μmol/L vs.153.08(3.23-776.26) μmol/L, U=-2.283, P=0.027], albumin [35.02(22.89-45.30) g/L vs.28.90(18.30-40.26) g/L, U=4.640, P=0.000], alanine aminotransferase [1 626.10(23.01-9 518.41) U/L vs.533.08(7.02-5 163.83) U/L, U=2.992, P=0.004], aspartate aminotransferase [1 611.20(34.51-15 850.02) U/L vs.715.54(60.06-10 280.42) U/L, U=2.312, P=0.023], blood ammonia [71.02(16.04-148.56) μmol/L vs.81.02(33.04-274.02) μmol/L, U=-2.057, P=0.046], prothrombin time [23.10(13.61-81.23) s vs.33.91(12.62-84.57) s, U=-2.364, P=0.022], activated partial prothrombin time [52.91(4.02-181.02) s vs.67.35(31.20-180.02) s, U=-2.226, P=0.029], and end-stage liver disease model score [13.00(-9.00-52.00) score vs.27.50(-9.00-88.00) score, U=-3.082, P=0.003] in the children with acute liver failure between the survival group and the death group.Multivariate Logistic regression analysis showed that total bilirubin (OR=0.236, 95%CI: 0.059-0.946, P=0.041), albumin(OR=0.854, 95%CI: 0.746-0.976, P=0.019), enzyme bile separation (OR=1.063, 95%CI: 1.031-1.119, P=0.005) and hepatic encephalopathy (OR=1.439, 95%CI: 1.021-2.043, P=0.017) were risk factors for the prognosis of children with acute liver failure. Conclusions The level of the total bilirubin and the ratio of enzyme bile isolation and hepatic encephalopathy are positively correlated but the level of albumin is negatively correlated with the prognosis of critically ill children with acute liver failure. Key words: Critically ill; Child; Acute liver failure; Prognosis