{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T21:27:31Z","timestamp":1788643651097,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T00:00:00Z","timestamp":1583366400000},"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":[[2020,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives:<\/jats:title><jats:p>Acute\u2010on\u2010chronic liver failure (ACLF) is well\u2010studied in adults and characterized by decompensated cirrhosis, multi\u2010organ failure, and early mortality. Studies of ACLF in children are limited. We sought to characterize the prevalence and clinical factors associated with pediatric ACLF (PACLF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>A retrospective review of children 3 months to 18 years listed for liver transplantation and hospitalized for decompensated cirrhosis between January 2007 and December 2017 at a single pediatric hospital. Primary outcome was the development of PACLF, characterized as failure of at least 1 extrahepatic organ (mechanical ventilation, renal replacement therapy, vasoactive medications, grade III\/IV hepatic encephalopathy). Characteristics were recorded for each hospitalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Sixty\u2010six patients had 186 hospitalizations with mean age at admission 4.0\u200a\u00b1\u200a5.6 years and diagnosis of biliary atresia (BA) in 65%. PACLF developed in 20 patients during 23 hospitalizations (12%) and respiratory failure was most common (17\/23, 74%). Duration of intensive care unit stay, 13.1\u200a\u00b1\u200a1.2 days versus 0.6\u200a\u00b1\u200a0.6 days (<jats:italic>P<\/jats:italic>\u200a&lt;\u200a0.001) and length of stay, 24.3\u200a\u00b1\u200a5.0 days versus 7.9\u200a\u00b1\u200a1.9 days (<jats:italic>P<\/jats:italic>\u200a=\u200a0.003) were longer in PACLF compared with non\u2010PACLF. Mortality during PACLF hospitalizations was 22%. Clinical factors associated with PACLF were reported from a generalized linear mixed model and included increased admission creatinine (<jats:italic>P<\/jats:italic>\u200a&lt;\u200a0.0001), increased aspartate aminotransferase (AST) (<jats:italic>P<\/jats:italic>\u200a=\u200a0.014), increased international normalized ration (INR) (<jats:italic>P<\/jats:italic>\u200a=\u200a0.0015), and a positive blood culture (<jats:italic>P<\/jats:italic>\u200a=\u200a0.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p>In this pediatric series, PACLF developed in 12% of hospitalizations and mortality was high. Admission creatinine, AST, INR, and presence of a positive blood culture were associated with PACLF development.<\/jats:p><\/jats:sec>","DOI":"10.1097\/mpg.0000000000002695","type":"journal-article","created":{"date-parts":[[2020,3,6]],"date-time":"2020-03-06T12:43:03Z","timestamp":1583498583000},"page":"783-788","source":"Crossref","is-referenced-by-count":23,"title":["Admission Characteristics Identify Risk of Pediatric Acute\u2010on\u2010Chronic Liver Failure"],"prefix":"10.1002","volume":"70","author":[{"given":"Anna M.","family":"Banc\u2010Husu","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Northwestern University Feinberg School of Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Neighbors","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Northwestern University Feinberg School of Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Rychlik","sequence":"additional","affiliation":[{"name":"Ann &amp; Robert H. Lurie Children's Hospital of Chicago, Biostatistical Research Core, Stanley Manne Children's Research Institute IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Northwestern University Feinberg School of Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zena Leah","family":"Harris","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Pediatrics Northwestern University Feinberg School of Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estella M.","family":"Alonso","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Northwestern University Feinberg School of Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,5]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2005.10.013"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27077"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-008-9106-x"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001179"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-010-9217-z"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e318228d7da"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001181"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2017.08.007"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.10.001"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13339"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v7.i3.392"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PCC.0000149131.72248.E6"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-014-9580-2"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.2174\/1875041901104010004"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-3301"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc11454"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc5713"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5002231"},{"key":"e_1_2_5_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13693"},{"key":"e_1_2_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.12.029"},{"key":"e_1_2_5_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-018-3893-7"}],"container-title":["Journal of Pediatric Gastroenterology and Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/MPG.0000000000002695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T10:23:41Z","timestamp":1750155821000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1097\/MPG.0000000000002695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,5]]},"references-count":22,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1097\/MPG.0000000000002695"],"URL":"https:\/\/doi.org\/10.1097\/mpg.0000000000002695","archive":["Portico"],"relation":{},"ISSN":["0277-2116","1536-4801"],"issn-type":[{"value":"0277-2116","type":"print"},{"value":"1536-4801","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,5]]}}}