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New Consensus Criteria on Liver Dysfunction in Critically Ill Children

April 9, 2022

In January 2022, the journal Pediatrics from the American Academy of Pediatrics published findings from the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Consensus Conference.

PODIUM sought to develop consensus criteria on organ dysfunction in critically ill children by evaluating the existing evidence base across the various organ systems and develop standardized metrics and qualifications for defining organ dysfunction that goes beyond the classical approach of expert opinion.

James E. Squires, MD, MS, from the UPMC Children’s Hospital of Pittsburgh Division of Pediatric Gastroenterology, Hepatology and Nutrition was the lead author of the liver dysfunction criteria in critically ill children. Former UPMC Children’s Hepatology Program faculty Robert H. Squires, MD, and Patrick J. McKiernan, MD, also were senior authors of study.

Dr. Squires is an associate professor of pediatrics, associate director of Hepatology, and the program director of the Advanced/Transplant Hepatology Fellowship Program.

Highlights from the Liver Dysfunction Consensus Study

The PODIUM team reviewed the existing evidence in the literature from 1992 to 2020, and the most widely used current measures for classifying acute liver dysfunction in pediatric patients to derive updated consensus criteria for establishing the presence of acute liver dysfunction in children with critical illness.

Based upon the evidence, the derived consensus criteria for acute liver dysfunction entails, “…in the absence of known chronic liver disease, as having onset of symptoms <8 weeks, combined with biochemical evidence of acute liver injury, and liver-based coagulopathy, with hepatic encephalopathy required for an international normalized ration between 1.5 and 2.0.”

With this set of criteria, the patient’s clinical trajectory has a high degree of likelihood for any of the three typical outcomes: necessity for transplantation, death, or alive with their native liver.

While the new criteria is not necessarily predictive of the need for transplant or mortality, prompt recognition of acute liver failure in patients meeting the new consensus criteria should be cause for increased monitoring and additional consultation with a liver transplantation program should liver failure in a critically ill child be the likely cause of multiple organ failure.  

Learn more about the PODIUM Collaborative and the new consensus criteria on acute liver dysfunction using the link below.

Learn more about Dr. Squires and the Hepatology and Liver Transplantation Program at UPMC Children’s.


Squires JE, McKeirnan PJ, Squires RH, on Behalf of the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Collaborative. Acute Liver Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference. Pediatrics. 2022; 149 (Supplement_1): S59-S65.