Pediatric Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain.
Liver Int. 2014 May;34(5):689-94. doi: 10.1111/liv.12298. Epub 2013 Sep 24.
BACKGROUND & AIMS: Pediatric acute liver failure is a rare disorder which results in death or the need for liver transplantation in 25-50% of cases. The adults scores are unable to predict survival without liver transplantation of pediatric patients. The present study assessed the use the of indocyanine green plasma disappearance rate as a tool to predict the evolution of pediatric patients with acute liver failure.
All patients met the criteria of acute liver failure according to the Pediatric Acute Liver Failure Study Group. King's College, Clichy's criteria and ICG-PDR were obtained on admission or when acute liver failure was diagnosed and repeated every 12-24 hours, respectively.
Thirteen out of 48 patients suffered an irreversible liver damage. Seven of them underwent a liver transplantation and 6 died on the waiting. A total of 154 ICG-PDR measurements were taken during the study (Median 12.4 %/min, r:6.2 - 26.3). The ICG-PDR was significantly lower in patients who suffered irreversible liver damage compared with those who survived without liver transplantation (median ICG-PDR 4.1 %/min; r:4.0 - 5.7 vs median ICG-PDR 20.3 %/min; r: 9.1 - 30.1; respectively. P < 0.001). Using a ROC curve the cutoff of ICG-PDR for assessing the need for liver transplantation was set at 5.9 %/min (sensitivity 92.3%, specificity 97.1%). Sensitivity, specificity, PPV, NPV and DA for ICG-PDR were higher than the King's College and Clichy's criteria.
ICG-PDR is a powerful tool that would improve the categorization of patients with pediatric acute liver failure.
小儿暴发性肝衰竭是一种罕见疾病，其导致死亡或需要肝移植的比例为 25-50%。目前的评分系统不能预测未进行肝移植的小儿患者的存活率。本研究评估了使用吲哚菁绿血浆清除率作为工具来预测急性肝衰竭患儿的预后。
所有患者均符合小儿暴发性肝衰竭研究组的急性肝衰竭标准。入院时或诊断为急性肝衰竭时获得 King's 学院、Clichy 标准和 ICG-PDR，并分别每 12-24 小时重复一次。
48 例患者中有 13 例发生不可逆肝损伤。其中 7 例进行了肝移植，6 例在等待中死亡。在研究期间共进行了 154 次 ICG-PDR 测量（中位数为 12.4%/min，r：6.2-26.3）。与未进行肝移植而存活的患者相比，发生不可逆肝损伤的患者的 ICG-PDR 显著降低（中位数 ICG-PDR 为 4.1%/min，r：4.0-5.7 与中位数 ICG-PDR 为 20.3%/min，r：9.1-30.1；分别为 P<0.001）。使用 ROC 曲线确定 ICG-PDR 评估肝移植需求的截止值为 5.9%/min（敏感性为 92.3%，特异性为 97.1%）。ICG-PDR 的敏感性、特异性、PPV、NPV 和 DA 均高于 King's 学院和 Clichy 标准。
ICG-PDR 是一种强大的工具，可以改善小儿暴发性肝衰竭患者的分类。
