{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T07:53:39Z","timestamp":1789890819735,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2005,5,1]],"date-time":"2005-05-01T00:00:00Z","timestamp":1114905600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2005,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective:<\/jats:title><jats:p>To study the etiology, outcome and prognostic indicators in children with fulminant hepatic failure in the United Kingdom.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design:<\/jats:title><jats:p>Retrospective review of all patients &lt;17 years with fulminant hepatic failure from 1991 to 2000. Fulminant hepatic failure was defined as presence of coagulopathy (prothrombin time &gt;24 seconds or International Normalized Ratio &gt;2.0) with or without hepatic encephalopathy within 8 weeks of the onset of symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting:<\/jats:title><jats:p>Liver Unit, Birmingham Children's Hospital, United Kingdom.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Ninety\u2010seven children (48 male, 49 female; median age, 27 months; range, 1 day\u2010192.0 months) were identified with fulminant hepatic failure. The etiologies were: 22 metabolic, 53 infectious, 19 drug\u2010induced, and 3 autoimmune hepatitis. The overall survival rate was 61%. 33% (32\/97) recovered spontaneously with supportive management. Fifty\u2010five children were assessed for liver transplantation. Four were unstable and were not listed for liver transplantation; 11 died while awaiting liver transplantation. Liver transplantation was contraindicated in 10 children. Of the 40 children who underwent liver transplantation, 27 survived. Children with autoimmune hepatitis, paracetamol overdose or hepatitis A were more likely to survive without liver transplantation. Children who had a delay between the first symptom of liver disease and the onset of hepatic encephalopathy (median, 10.5 days versus 3.5 days), higher plasma bilirubin (299 \u03bcmol\/L versus 80 \u03bcmol\/L), higher prothrombin time (62 seconds versus 40 seconds) or lower alanine aminotransferase (1288 IU\/L versus 2929 IU\/L) levels on admission were more likely to die of fulminant hepatic failure or require liver transplantation (<jats:italic>P<\/jats:italic> &lt; 0.05). On multivariate analysis, the significant independent predictors for the eventual failure of conservative therapy were time to onset of hepatic encephalopathy &gt;7 days, prothrombin time &gt;55 seconds and alanine aminotransferase \u22642384 IU\/L on admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>Children with fulminant hepatic failure with severe coagulopathy, lower alanine aminotransferase on admission and prolonged duration of illness before the onset of hepatic encephalopathy are more likely to require liver transplantation. Early referral to a specialized center for consideration of liver transplantation is vital.<\/jats:p><\/jats:sec>","DOI":"10.1097\/01.mpg.0000158524.30294.e2","type":"journal-article","created":{"date-parts":[[2005,4,28]],"date-time":"2005-04-28T08:01:24Z","timestamp":1114675284000},"page":"575-581","source":"Crossref","is-referenced-by-count":177,"title":["Etiology, Outcome and Prognostic Indicators of Childhood Fulminant Hepatic Failure in the United Kingdom"],"prefix":"10.1002","volume":"40","author":[{"given":"Way Seah","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Paediatrics University of Malaya Medical Centre Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"McKiernan","sequence":"additional","affiliation":[{"name":"Liver Unit Birmingham Children's Hospital Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deirdre Anne","family":"Kelly","sequence":"additional","affiliation":[{"name":"Liver Unit Birmingham Children's Hospital Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2005,5]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"179","volume-title":"Pediatric Gastrointestinal Disease, Pathophysiology, Diagnosis, Management","author":"Treem WR","year":"2000"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-198707000-00015"},{"key":"e_1_2_5_4_1","first-page":"1107","article-title":"Fulminant hepatic failure: etiology, viral markers and outcome","volume":"36","author":"Bendre SV","year":"1999","journal-title":"Indian Pediatr"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.105.2.436"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2000.tb123872.x"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.87.1.54"},{"key":"e_1_2_5_8_1","first-page":"34","article-title":"Fulminant hepatitis in children in Taiwan: the important role of hepatitis B virus","volume":"3","author":"Chang MH","year":"1986","journal-title":"J Pediatr"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1007248"},{"key":"e_1_2_5_10_1","first-page":"A125","article-title":"Acute liver failure in infancy [abstract]","volume":"23","author":"Mieli\u2010Vergani G","year":"1995","journal-title":"J Hepatol"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199309001-00027"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840160509"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2001.119989"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(98)90521-8"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(89)90081-4"},{"key":"e_1_2_5_16_1","first-page":"63","volume-title":"Liver Disease in Children","author":"Whitington PF","year":"2001"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.45.1.93"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005176-199702000-00004"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.500050102"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(88)90011-X"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)91736-6"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.55.4.252"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005176-199804000-00024"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200103150-00003"},{"key":"e_1_2_5_25_1","first-page":"1271","volume-title":"Pediatric Gastrointestinal Disease, Pathophysiology, Diagnosis, Management","author":"Kelly D","year":"2000"}],"container-title":["Journal of Pediatric Gastroenterology and Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/01.MPG.0000158524.30294.E2","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T15:37:04Z","timestamp":1706888224000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1097\/01.MPG.0000158524.30294.E2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,5]]},"references-count":24,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2005,5]]}},"alternative-id":["10.1097\/01.MPG.0000158524.30294.E2"],"URL":"https:\/\/doi.org\/10.1097\/01.mpg.0000158524.30294.e2","archive":["Portico"],"relation":{},"ISSN":["0277-2116","1536-4801"],"issn-type":[{"value":"0277-2116","type":"print"},{"value":"1536-4801","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,5]]}}}