The most frequent cause of pediatric acute liver failure (PALF) in developing countries is hepatitis A virus (HAV) infection. By means of the present study, Lal and colleagues sought to develop and validate a HAV-etiology specific prognostic model in PALF.

Children with PALF induced by HAV (IgM HAV reactive) were recruited in the study. 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 was associated with 131 (45.9%) of the 285 PALF in the study. Eleven children who underwent liver transplant were excluded; 120 children (74 survivors and 46 deaths) were included. The derivation cohort included the first 75 patients while the next 45 patients formed the prospective validation cohort.

In the derivation cohort, INR, grade of hepatic encephalopathy (HE) and jaundice-to-HE interval independently predicted death. The final model included the three following 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 had a sensitivity of 90%, specificity of 81.4% and accuracy of 84.9% in predicting death. Peds-HAV model was found to be superior to the existing prognostic models. In the validation cohort, the new model predicted death with 83.3% sensitivity and 92.6% specificity.

To conclude, the Peds-HAV model is a simple, bedside, dynamic, etiology (HAV) specific prognostic model which is based on 3 objective parameters with excellent sensitivity and specificity. This model should be put to use as liver transplant listing criteria in HAV-induced PALF.

Source: Lal BB, Sood V, Snehavardhan P, et al. A Novel, Bedside, Etiology Specific Prognostic Model (Peds-HAV) in Hepatitis A Induced Pediatric Acute Liver Failure. Hepatol Int. 2020 May 5.