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Multicenter Study
. 2009 Dec;155(6):801-806.e1.
doi: 10.1016/j.jpeds.2009.06.005. Epub 2009 Jul 29.

Pattern of diagnostic evaluation for the causes of pediatric acute liver failure: an opportunity for quality improvement

Michael R Narkewicz  1 , Dominic Dell Olio, Saul J Karpen, Karen F Murray, Kathy Schwarz, Nada Yazigi, Song Zhang, Steven H Belle, Robert H Squires; Pediatric Acute Liver Failure Study Group
Affiliations
Multicenter Study

Pattern of diagnostic evaluation for the causes of pediatric acute liver failure: an opportunity for quality improvement

Michael R Narkewicz et al. J Pediatr. 2009 Dec.

Abstract

Objective: To describe the frequency of diagnostic testing for the 4 most common causes of pediatric acute liver failure (PALF) (drugs, metabolic disease, autoimmune process, and infections) in indeterminate PALF within the PALF Study Group Database.

Study design: PALF was defined by severe hepatic dysfunction within 8 weeks of onset of illness, with no known underlying chronic liver disease in patients from birth through 17 years of age.

Results: Of the 703 patients in the database, 329 (47%) had indeterminate PALF. In this group, a drug history was obtained in 325 (99%) urine toxicology screenings performed in 118 (36%) and acetaminophen level measured in 124 (38%) patients. No testing for common metabolic diseases was done in 179 (54%) patients. Anti-nuclear antibody, anti-smooth muscle antibody, and anti-liver kidney microsomal autoantibodies associated with autoimmunity were determined in 239 (73%), 233 (71%), and 208 (63%) patients, and no tests were obtained in 70 (21%). Testing was performed for hepatitis A virus, hepatitis B virus, and Epstein Barr virus in 80%, 86%, and 68%, respectively.

Conclusions: Current practice indicates that investigation for metabolic and autoimmune causes of PALF are infrequent in patients ultimately given a diagnosis of indeterminate acute liver failure. This offers an opportunity to improve diagnosis and potential treatment options in children with acute liver failure.

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Conflict of interest statement

The authors declare no conflicts of interest.

Comment in

References

    1. Aydogdu S, Ozgenc F, Yurtsever S, Akman SA, Tokat Y, Yagci RV. Our experience with fulminant hepatic failure in Turkish children: etiology and outcome. J Trop Pediatr. 2003;49:367–70. - PubMed
    1. Liu E, MacKenzie T, Dobyns EL, Parikh CR, Karrer FM, Narkewicz MR, et al. Characterization of acute liver failure and development of a continuous risk of death staging system in children. J Hepatol. 2006;44:134–41. - PubMed
    1. Ee LC, Shepherd RW, Cleghorn GJ, Lewindon PJ, Fawcett J, Strong RW, et al. Acute liver failure in children: A regional experience. J Paediatr Child Health. 2003;39:107–10. - PubMed
    1. Squires RH, Jr, Shneider BL, Bucuvalas J, Alonso E, Sokol RJ, Narkewicz MR, et al. Acute liver failure in children: the first 348 patients in the pediatric acute liver failure study group. J Pediatr. 2006;148:652–8. - PMC - PubMed
    1. Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137:947–54. - PubMed

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