Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.
Hepatol Int. 2020 Jul;14(4):483-490. doi: 10.1007/s12072-020-10050-0. Epub 2020 May 5.
Hepatitis A virus (HAV) is the commonest cause of pediatric acute liver failure (PALF) in developing countries. Our objective was to develop and validate a HAV-etiology specific prognostic model in PALF.
All children with HAV induced PALF (IgM HAV reactive) were included. Outcome was defined at day 28. Only those with death or native liver survival were included. The model (Peds-HAV) was derived using the independent predictors of outcome and validated in a prospective independent cohort.
Hepatitis A accounted for 131 (45.9%) of total 285 PALF. After excluding 11 children who underwent liver transplant, 120 children (74 survivors and 46 death) were included. The first 75 patients formed the derivation cohort and the next 45 patients formed the prospective validation cohort. In the derivation cohort, INR: OR 2.208, (95% CI 1.321-3.690), p = 0.003, grade of hepatic encephalopathy (HE): OR 3.078, (95% CI 1.017-9.312), p = 0.047 and jaundice-to-HE interval: OR 1.171, (95% CI 1.044-1.314), p = 0.007 were independent predictors of death. The final model comprised three criteria: (1) presence of grade 3-4 HE, (2) INR greater than 3.1, and (3) jaundice to HE interval more than 10 days. Presence of 2 or more of these criteria predicted death with 90% sensitivity, 81.4% specificity and 84.9% accuracy. Peds-HAV model was superior to existing prognostic models. In the validation cohort, Peds-HAV model predicted death with 83.3% sensitivity and 92.6% specificity.
Peds-HAV model is a simple, bedside, dynamic, etiology (HAV) specific prognostic model based on 3 objective parameters with optimum sensitivity and specificity, hence should be used as liver transplant listing criteria in HAV induced PALF.
甲型肝炎病毒（HAV）是发展中国家小儿急性肝衰竭（PALF）最常见的病因。我们的目的是建立并验证一个针对 PALF 中 HAV 病因的预后模型。
所有 HAV 引起的 PALF（IgM HAV 阳性）患儿均被纳入研究。28 天为结局评估时间点。仅纳入死亡或接受肝移植的患儿。采用结局的独立预测因子建立模型（Peds-HAV），并在前瞻性独立队列中进行验证。
甲型肝炎导致 285 例 PALF 患儿中的 131 例（45.9%）。排除 11 例行肝移植的患儿后，共纳入 120 例患儿（74 例存活，46 例死亡）。前 75 例患儿为推导队列，接下来的 45 例患儿为前瞻性验证队列。推导队列中，INR：比值比 2.208（95%可信区间 1.321-3.690），p=0.003，肝性脑病（HE）分级：比值比 3.078（95%可信区间 1.017-9.312），p=0.047，黄疸至 HE 间隔时间：比值比 1.171（95%可信区间 1.044-1.314），p=0.007 是死亡的独立预测因子。最终模型包括三个标准：（1）存在 3-4 级 HE；（2）INR 大于 3.1；（3）黄疸至 HE 间隔时间大于 10 天。2 个或更多标准存在预测死亡的敏感性为 90%，特异性为 81.4%，准确性为 84.9%。Peds-HAV 模型优于现有预后模型。在验证队列中，Peds-HAV 模型预测死亡的敏感性为 83.3%，特异性为 92.6%。
Peds-HAV 模型是一种基于 3 个客观参数的简单、床边、动态、病因（HAV）特异性预后模型，具有最佳的敏感性和特异性，因此应作为 HAV 引起的 PALF 患者肝移植的适应证标准。
