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Predictive value of indocyanine green clearance in acute liver failure in children: comparison with King's College and Clichy scores

Introduction

Indocyanine green clearance (ICG), measured by the percentage disappearance rate (PDR), detects alterations in liver function and may be used as a noninvasive determinant of hepatic reserve in liver failure as well as a marker of graft function following liver transplantation. The administration of blood products does not interfere with the ICG-PDR as occurs with other prognostic scores (King's College and Clichy scores). The aims of this study were to compare in acute liver failure the ICG-PDR with King's College and Clichy scores and to determinate its predictive value.

Methodology

Between 2003 and 2006, 114 ICG-PDRs were performed in 38 children (mean age 2.6 years (range 1 month–16 years)) with acute liver damage. ICG was administrated intravenously and its blood concentration was detected over time by transcutaneous pulse densitometry using a commercially available bedside monitor. The PDR was performed under hemodynamic stability (systolic mean pressure >60 mmHg; saturation of central venous blood saturation >70% and CO2 arterio-venous difference <8 mmHg).

Results

The mean number of PDRs/patient was three. The mean PDR was 17% (range: 3.3–51%). In two out of 38 patients, the PDR could not be detected due to hemodynamic instability. PDR < 5% was a predictor value for irreversible liver failure (P = 0.000). In nine (25%) out of 36 patients, the PDR was <5%. Of those nine, two patients recovered its synthetic function and seven (78%) patients developed irreversible liver failure (four died of liver failure and three underwent liver transplantation) (see Table 1).

Table 1 (abstract P398)

Conclusion

ICG-PDR < 5% is a significant predictor of irreversible liver failure. It is a good complement of such scores for decision-making.

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Quintero, J., Ortega, J., Bueno, J. et al. Predictive value of indocyanine green clearance in acute liver failure in children: comparison with King's College and Clichy scores. Crit Care 11, P398 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5558

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Keywords

  • Liver Transplantation
  • Liver Failure
  • Indocyanine Green
  • Graft Function
  • Acute Liver Failure