{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:46:26Z","timestamp":1784259986672,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T00:00:00Z","timestamp":1607472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Acute liver failure (ALF) is a rare disease, associated with high mortality, despite optimal medical therapy without emergency liver transplantation. Knowing the possible cause of ALF plays a vital role in the management, as the child could benefit from effective specific therapies in emergencies. Methods: We have analyzed the etiology and outcome of ALF in children followed-up in a tertiary care hospital between January 2012\u2013December 2018. The patients were grouped into different age categories: neonates (0\u20131 month), infants (1\u201312 months), children (1\u201314 years), and teenagers (14\u201318 years). Results: 97 children (46 males, 47.42%, the mean age of 7.66 \u00b1 8.18 years) were admitted with ALF. The most important causes of ALF were in neonates and infants, infections (72.72%), and metabolic disorders (43.47%), in children and adolescents were the toxic causes (60% and 79.41%). The mortality rate was 31.95% (31 patients), mainly in ALF due to infections or metabolic disorders. Conclusions: In neonates and infants, the main causes of ALF were infections and metabolic diseases, while in older children and teenagers, were toxin-induced liver injuries. The mortality among neonates and infants was significantly higher than in other ages. Early recognition and immediate therapeutic intervention could improve the outcome of these patients.<\/jats:p>","DOI":"10.3390\/children7120282","type":"journal-article","created":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T09:17:58Z","timestamp":1607505478000},"page":"282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Etiology and Outcome of Acute Liver Failure in Children\u2014The Experience of a Single Tertiary Care Hospital from Romania"],"prefix":"10.3390","volume":"7","author":[{"given":"Alina","family":"Grama","sequence":"first","affiliation":[{"name":"2nd Pediatric Clinic, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"},{"name":"Center of Expertise in Pediatric Liver Rare Disorders, 2nd Pediatric Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania"},{"name":"University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornel Olimpiu","family":"Aldea","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Burac","sequence":"additional","affiliation":[{"name":"2nd Pediatric Clinic, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"},{"name":"Center of Expertise in Pediatric Liver Rare Disorders, 2nd Pediatric Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Delean","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Bulata","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Sirbe","sequence":"additional","affiliation":[{"name":"2nd Pediatric Clinic, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Duca","sequence":"additional","affiliation":[{"name":"2nd Pediatric Clinic, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dora","family":"Boghitoiu","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Coroleuca","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4931-1219","authenticated-orcid":false,"given":"Tudor Lucian","family":"Pop","sequence":"additional","affiliation":[{"name":"2nd Pediatric Clinic, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"},{"name":"Center of Expertise in Pediatric Liver Rare Disorders, 2nd Pediatric Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.clinre.2011.03.005","article-title":"Acute liver failure in children","volume":"Volume 35","author":"Poupon","year":"2011","journal-title":"Clinics and Research in Hepatology and Gastroenterology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1055\/s-2008-1073115","article-title":"Acute Liver Failure in Children","volume":"28","author":"Squires","year":"2008","journal-title":"Semin. Liver Dis."},{"key":"ref_3","first-page":"A1","article-title":"Acute liver failure in children: Aetiology and evolution","volume":"104","author":"Grama","year":"2019","journal-title":"Arch. Dis. Child."},{"key":"ref_4","unstructured":"Deirdre, K. (2008). Fulminant Hepatitis and Acute Liver Failure. Diseases of the Liver and Biliary System in Children, Wiley-Blackwell. [3rd ed.]."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Grama, A., Aldea, C., Burac, L., Delean, D., Boghitoiu, D., Bulata, B., Nitescu, V., Ulmeanu, C., and Pop, T. (2019). Acute liver failure secondary to toxic exposure in children. Arch. Med. Sci., 15.","DOI":"10.5114\/aoms.2019.87716"},{"key":"ref_6","unstructured":"Hay, W.W., Levin, J.M., Sondheimer, M.J., and Deterding, R.R. (2011). Liver and pancreas. Current Diagnosis & Treatment Paediatrics, Mc Graw Hill Education. [20th ed.]."},{"key":"ref_7","unstructured":"Mauss, S., Berg, T., Sarazzin, J., and Wedemeyer, H. (2017). Acute Liver Failure. Hepatology\u2014A Clinical Textbook, Flying Publisher. [6th ed.]."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S80","DOI":"10.1002\/lt.21641","article-title":"Etiology and Prognosis of Acute Liver Failure in Children","volume":"14","author":"Dhawan","year":"2008","journal-title":"Liver Transplant."},{"key":"ref_9","unstructured":"Iordachescu, F. (2019). Insuficienta hepatica acuta. Tratat de Pediatrie, Editura ALL."},{"key":"ref_10","first-page":"69","article-title":"Acute liver failure related to inherited metabolic diseases in young children","volume":"88","author":"Costa","year":"2018","journal-title":"An. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Grama, A., Blaga, L., Nicolescu, A., Deleanu, K., Militaru, M., C\u0103inap, S.S., Pop, I., Tita, G., Sirbe, C., and Fufezan, O. (2019). Novel Mutation in GALT Gene in Galactosemia Patient with Group B Streptococcus Meningitis and Acute Liver Failure. Medicina, 55.","DOI":"10.3390\/medicina55040091"},{"key":"ref_12","first-page":"64","article-title":"Acute liver failure and acquired aplastic anaemia in children-life-threatening clinical entities of common etiopathogenesis?","volume":"9","author":"Liberek","year":"2003","journal-title":"Med. Sci. Monit."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"14","DOI":"10.17140\/LROJ-2-111","article-title":"Pediatric Acute Liver Failure: Current Perspectives","volume":"2","author":"Colleti","year":"2017","journal-title":"Liver Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.clinre.2012.03.022","article-title":"Acute Liver Failure in children and adolescents","volume":"36","author":"Dhawan","year":"2012","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/MPG.0000000000001202","article-title":"Liver Failure in Early Infancy: Aetiology, Presentation, and Outcome","volume":"64","author":"Bitar","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.jpeds.2005.12.051","article-title":"Acute liver failure in children: The first 348 patients in the paediatric acute liver failure study group","volume":"148","author":"Squires","year":"2006","journal-title":"J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1002\/hep.28944","article-title":"Pediatric Acute Liver Failure of Undetermined Cause: A Research Workshop","volume":"65","author":"Alonso","year":"2017","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1586\/egh.11.57","article-title":"Acute Liver Failure in Neonates, Infants and Children","volume":"5","author":"Devictor","year":"2011","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2576","DOI":"10.1080\/14767058.2018.1555806","article-title":"Neonatal acute liver failure due to enteroviruses: A 14-th years single NICU experience","volume":"33","author":"Bersani","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_20","first-page":"1981","article-title":"Inborn Errors of Metabolism in Infancy and Early Childhood: An Update","volume":"73","author":"Raghuveer","year":"2006","journal-title":"Am. Fam. Physician"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.jpeds.2011.04.016","article-title":"Characterization and outcomes of young infants with acute liver failure","volume":"159","author":"Sundaram","year":"2011","journal-title":"J. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"559","DOI":"10.20344\/amp.6195","article-title":"A Import\u00e2ncia da Referencia\u00e7\u00e3o Precoce na Fal\u00eancia Hep\u00e1tica Aguda Pedi\u00e1trica","volume":"28","author":"Moinho","year":"2015","journal-title":"Acta Med. Port."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S304","DOI":"10.1016\/S0168-8278(16)00397-4","article-title":"PELD score as a prognostic factor in fulminant liver failure caused by mushroom poisoning in children","volume":"64","author":"Pop","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"70","DOI":"10.5005\/jp-journals-10018-1172","article-title":"Viral Hepatitis in Pakistan: Past, Present, and Future","volume":"6","author":"Butt","year":"2016","journal-title":"Euroasian J. Hepatogastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1542\/peds.105.2.436","article-title":"Liver failure attributable to hepatitis A virus infection in a developing country","volume":"105","author":"Shah","year":"2000","journal-title":"Pediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1111\/liv.13370","article-title":"Profile and outcome of first 109 cases of paediatric acute liver failure at a specialized paediatric liver unit in India","volume":"37","author":"Alam","year":"2017","journal-title":"Liver Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"451","DOI":"10.2217\/14750708.5.4.451","article-title":"Fulminant hepatic failure in children","volume":"5","author":"Gugig","year":"2008","journal-title":"Therapy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/INF.0b013e3180f60bed","article-title":"Hepatitis A as an etiologic agent of acute liver failure in Latin America","volume":"26","author":"Ciocca","year":"2007","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/S1665-2681(19)30767-7","article-title":"Etiology, outcome, and prognostic factors of childhood acute liver failure in a German Single Center","volume":"14","author":"Kathemann","year":"2015","journal-title":"Ann. Hepatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"35","DOI":"10.5152\/tjg.2014.4231","article-title":"Acute liver failure in Turkey: A systematic review","volume":"25","author":"Kayaalp","year":"2014","journal-title":"Turk. J. Gastroenterol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/7\/12\/282\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:42:53Z","timestamp":1760179373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/7\/12\/282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,9]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["children7120282"],"URL":"https:\/\/doi.org\/10.3390\/children7120282","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,9]]}}}