Abstract: Objective To investigate the etiology and clinical outcome of 76 children with acute liver failure (ALF). Methods A total of 76 children (43 males and 33 females) with ALF admitted to our hospital from January 2010 to January 2021 were included, with an average age of 1 month to 12 years. All the objects were followed up regularly and death group according to the clinical outcome. The etiology of ALF children were collected, and the clinical data of survival group and death group were compared and analyzed by multiple-factor analysis. Results The etiology of 31 (40.8%) cases was unclear and etiology of 45 (59.2%) cases was definite. Among the latter, 14 cases were drug-induced injury (18.4%), 11 cases were infectious diseases (15.8%), 9 cases were anatomical abnormalities (congenital dysplasia of blood vessels or biliary tract) (14.5%), 7 cases were hereditary metabolic diseases (9.2%), 3 cases were autoimmune diseases (3.9%) and 1 case was neoplastic diseases (1.3%). Among the 76 children with ALF, 44 cases survived and 32 cases died, respectively. Compared with clinical data, the alanine transaminase (ALT) and aspartate aminotransferase (AST) [1108 (504, 3114) U/L and 1226 (808, 3225) U/L] in the survival group were significantly higher than those in the death group [526 (204, 915) U/L and 717 (470,1948) U/L, Z=27.402, 24.153, P<0.05]. In the survival group, the albumin (Alb), total bilirubin (TBil), direct bilirubin (DBil) and blood ammonia of survival group [33.2 (30.2, 38.4) g/L, 61.2 (26.5, 182.4) μmol/L, 38.0 (12.9, 114.8) μmol/L and 80.0 (60.5, 101.7) μmol/L] were significantly different from those in death group [28.7 (26.0, 31.4) g/L、152.9(70.6, 288.0) μmol/L, 87.6 (41.6, 158.2) μmol/L and 109.5 (85.5, 146.6) μmol/L], P<0.05. The survival group plotting time PT and international normalized ratio (INR) were 24.2(21.0, 29.8) s and 2.1(1.8, 2.8), which was significantly different from the death group [38.4(24.4, 52.5) s and 3.3(2.3, 6.6)] (Z=-20.197, -21.158, P<0.05). PELD score of survival group [20.2 (18.4, 32.0) points] was significantly higher than that of death group [30.8 (24.6, 39.0) points, Z=-22.278, P<0.05]. Taking the ALT, AST, Alb, TBil, DBil, blood ammonia, PT, INR and PELD score as independent variables, and the clinical outcome was taken as dependent variable (assigned 0 = survival, 1 = death), and the logistic regression analysis was conducted. The results indicated that TBil and PELD scores were independent risk factors of death in the clinical outcome of children with ALF (P<0.05). Conclusion The mortality of children with ALF is high, and the common causes are drug-induced damage, infectious diseases, anatomical abnormalities (congenital dysplasia of blood vessels or biliary tract), genetic metabolic diseases, autoimmune diseases and neoplastic diseases. The increase of TBil and PELD scores in children with ALF indicates poor prognosis.

Key words: Acute liver failure, Children, Pediatric end-stage liver disease score