Children live with low HRQOL, motor skill deficits post-acute liver failure

BOSTON — Researchers found that children and adolescents showed deficits in executive function, motor skills and health-related quality of life after surviving acute liver failure, according to data presented in a transplant plenary session at The Liver Meeting.

“These findings are consistent with our previously published cross-sectional study, also using the PALF Study Group, which found similar results in pediatric acute liver failure survivors who returned for testing up to 6 years after illness,” Lisa G. Sorensen, PhD, from the department of psychiatry and behavioral sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, said during her presentation.

Lisa G. Sorensen

In this multi-center study, Sorensen and colleagues evaluated data from the PALF Study Group looking at neurocognitive impairment and health-related quality of life (HRQOL) in 158 pediatric patients recovering from acute liver failure. At 6 and 12 months after enrollment, patients between 2 and 16 years of age underwent surveys of executive function and patients between ages 2 and 19 years completed the HRQOL survey.

“The aim was to compare HRQOL in PALF survivors to a matched sample of healthy children and prevalence of neurocognitive impairment in PALF survivors,” Sorensen said.

The control group consisted of 828 healthy children, according to Sorensen’s presentation.

A total of 25 patients completed neurocognitive testing and 52 had parent-report HRQOL data at 6 months and 43 at 1 year. Of these patients, 44% who completed neurocognitive testing and 48% who completed HRQOL had indeterminate etiology; 28% who completed neurocognitive testing and 21% who completed HRQOL had peak hepatic encephalopathy (HE) grade 3 or 4; and 52% who completed neurocognitive testing and 50% who had HRQOL underwent a liver transplant.

The Beery VMI-6 Motor Coordination (mean: 85.1±15.2) and Visual Motor Integration (mean: 90.3±14.1) decreased below normal levels (P < .001 for both), whereas Full Scale IQ on Wechsler Scales and attention on Conners Continuous Performance Test did not.

“HRQOL is lower in PALF patients compared with a healthy matched sample at 6 months and 12 months follow up, with self-reported outcomes lowest at 12 months,” Sorensen said.

Self and parent-report (for pre-school aged patients) on Pediatric Quality of Life Inventory 4.0 Generic and Multidimensional Fatigue scales decreased below normal in the healthy controls at 6 and 12 months (nearly all P < .001).

“Patients and parents report significantly higher levels of fatigue, including cognitive fatigue, in PALF survivors at 6 and 12-month follow-up,” Sorensen said.

Univariate analysis did not show age, parent education, liver transplant, HE and diagnosis to be predictors of any level of HE or motor deficits.

“Larger prospective studies are needed to further explore functional outcomes predictors,” Sorensen concluded. - by Melinda Stevens

Reference:

Sorensen LG, et al. Abstract 30. Presented at: The Liver Meeting; Nov. 11-15, 2016; Boston.

Disclosures: Sorensen reports no relevant financial disclosures.