Objectives:To determine short-term outcome for children with acute liver failure (ALF) as it relates to cause,clinical status,and patient demographics and to determine prognostic factors. Study design:A prospective,multicenter case study collecting demographic,clinical,laboratory,and short-term outcome data on children from birth to 18 years with ALF. Patients without encephalopathy were included if the prothrombin time and international normalized ratio remained ≥20 seconds and/or >2,respectively,despite vitamin K. Primary outcome measures 3 weeks after study entry were death,death after transplantation,alive with native liver,and alive with transplanted organ. Results:The cause of ALF in 348 children included acute acetaminophen toxicity (14%),metabolic disease (10%),autoimmune liver disease (6%),non-acetamino- phen drug-related hepatotoxicity (5%),infections (6%),other diagnosed conditions(10%); 49%were indeterminate. Outcome varied between patient sub-groups; 20%with non-acetaminophen ALF died or underwent liver transplantation and never had clinical encephalopathy. Conclusions:Causes of ALF in children differ from in adults. Clinical encephalopathy may not be present in children. The high percentage of indeterminate cases provides an opportunity for investigation.
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