Growth Mixture Modeling to Identify Patterns of the Development of Acute Liver Failure in Children

Pediatric Acute Liver Failure (PALF) is a clinical syndrome in which the affected children lose hepatic function and become critically ill within days. The causes of PALF remain indeterminate for about half of the cases. Liver transplantation is a lifesaving procedure but has long term adverse effects. It is critical to advance clinical insight by distinguishing patients who die without liver transplantation from those who are able to survive without transplantation. The PALF study is a multicenter study for children under 18 years old who present with acute liver failure. The study collected clinical and laboratory data for the first 7 days or until one of the events: death, transplantation or discharge occurred within 7 days following study enrollment. Growth Mixture Modeling (GMM) was applied to detect the trajectory patterns of INR (International Normalized Ratio) for hepatic-based coagulation through the first 7 days.\ud Three subgroups were identified by INR trajectories with 10.3% classified as high-INR, 34.7% as middle-INR and 55.0% as low-INR. The children with an indeterminate diagnosis were more likely to be classified into the high-INR group (p