![]() ![]() The total score was measured by summing the scores (maximum total score = 75). We developed a scoring algorithm to discriminate and summarize the quality of studies (Appendix 1). Since prognostic studies evaluated the possible prognostic factors, we did not assess the confounding variables therefore, the QUIPS tool was used in this study. The quality in prognosis studies (QUIPS) tool was used to examine the methodological quality ( 7). Disagreements were discussed and resolved in a consensus meeting. They identified potentially eligible articles by reviewing the full-texts independently and subsequently. After omitting duplicates in the Endnote software, two independent reviewers selected studies by screening their titles and abstracts, according to the inclusion and exclusion criteria. On the other hand, the exclusion criteria were as follows: (1) focus on only the prognostic factors for PALF complications or LT (2) comparison of the groups without prediction and (3) assessment of treatment effects (e.g., transplantation or supportive devices). The inclusion criteria were as follows: (1) a study population of children aged 0 - 18 years (2) identification of prognostic factors for PALF (3) evaluation of outcomes, including spontaneous survival, death without undergoing LT, and undergoing LT (4) a prospective or retrospective cohort design and (5) published studies in English. ![]() The inclusion criteria for all publications were defined before the search. The reference lists of all included studies were also reviewed to retrieve relevant publications. The literature search strategy is presented in Appendix 1. Also, “liver failure” and “prognosis” were used as the MeSH terms. The keywords included “pediatric acute liver failure”, “prediction”, “prognosis”, “epidemiology”, “child”, and “risk factors”. The PubMed, Embase, and Cochrane databases (from 1950 to November 20, 2020) were searched to identify prognostic studies on PALF. This systematic review and meta-analysis was conducted based on the PRISMA guidelines ( 6). In the present study, a systematic review and meta-analysis of prognostic studies was carried out, and the general prognostic factors predicting poor outcomes in studies on PALF were investigated for the development of a new prognostic model. To the best of our knowledge, there are no systematic reviews to determine the prognostic factors that may provide an ideal predictive model for PALF. Generally, an optimal predictive model should include some static and dynamic parameters ( 5). However, no optimal prognostic model has been developed for PALF so far. Multiple prognostic factors have been studied so far, including the international normalized ratio (INR), severity of hepatic encephalopathy (HE), and serum ammonia level ( 3, 4). In a large number of children, the cause of PALF remains undetermined ( 2) due to several factors, such as limitations of detection instruments.ĭue to the insufficient number of liver donations, it is necessary to identify patients with a poor prognosis to determine whether liver transplantation (LT) must be performed. Pediatric ALF (PALF) has a variety of age- and geography-related etiologies. Although the true incidence of ALF is unknown in pediatric patients, it has a high mortality rate, ranging from 24 to 53% ( 1). Further prognostic studies of PALF with larger cohorts are also needed.Īcute liver failure (ALF) is a life-threatening disease, characterized by a multi-system disorder, severe liver dysfunction with or without encephalopathy, and hepatocellular necrosis. ![]() Although these factors may contribute to the new prognostic model, they must be considered with caution. Etiology, ammonia, bilirubin, albumin, AST levels, severe HE (grade 3/4) were found associated with the poor outcomes or death (without LT) of PALF.
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