ÇOCUKLARDA AKUT KARACİĞER YETMEZLİĞİ: 18 YILLIK ÇOCUK YOĞUN BAKIM DENEYİMİ

Abstract

PELİT BAL P. Acute Liver Failure in Children: 18 Years of Pediatric Intensive Care Experience. Hacettepe University Faculty of Medicine, Department of Pediatrics, Residency Thesis, Ankara, 2025. Pediatric acute liver failure (PALF) is a condition characterized by rapidly developing liver dysfunction, accompanied by coagulopathy, hepatic encephalopathy, and multi-organ failure, with high mortality requiring urgent treatment. This study included a total of 45 patients (1 month-18 years) who were diagnosed with PALF and followed in the Pediatric Intensive Care Unit of Hacettepe University between January 1, 2007, and January 1, 2024. The etiology, clinical, laboratory findings of the patients, risk factors affecting prognosis, were evaluated. Patients were classified into Group 1 (recovered) and Group 2 (required liver transplantation or dead). 55.6% of the patients recovered, 33.3% underwent transplantation, and 11.1% died. Plasma exchange was performed in 75.6%, continuous renal replacement therapy (CRRT) in 31.1% of patients. The most common complication of ALF was hepatic encephalopathy (64.4%). The most common cause was toxicity (33.3%), mainly acetaminophen (46.7%), followed by indeterminate (20%), metabolic and infectious (15.5% each), Wilson's disease (11.1%), autoimmune and vascular (2.2% each). Toxic and infectious causes had better outcomes, while Wilson's disease and metabolic disorders showed poorer prognosis. Jaundice or splenomegaly at admission indicated worse outcomes, while diarrhea predicted better prognosis. Poor prognostic factors included hepatic encephalopathy, acute kidney injury, hyperammonemia, the need for mechanical ventilation and CRRT. In Group 2, PRISM, PDR, and PELD scores, as well as aPTT, total bilirubin, ammonia, and lactate levels were significantly higher, while hemoglobin and transaminase levels were lower. Mortality was strongly associated with total bilirubin >10.6mg/dL, lactate >3.6mmol/L, and PDR >5.65. The standardized mortality ratio (SMR) was found to be 0.31, indicating fewer-than-expected deaths. Persistently high INR despite treatment, rather than admission INR, was a strong indicator of poor prognosis. Treatment-resistant high INR, total bilirubin, and ammonia levels were identified as independent poor prognostic factors in ALF.