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

Zhang, Song (2012) Growth Mixture Modeling to Identify Patterns of the Development of Acute Liver Failure in Children. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

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.
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<0.0001) than were children with a specific diagnosis. The mortality without liver transplantation within 21 days of study entry was similar between the children in the high-INR group (19%) and in the middle-INR group (17%), (p=0.70). The percentage of participants having liver transplantation was significantly higher among the children in the high-INR group (61%) than those in the middle-INR group (46%), (p=0.01).
INR is used as a biomarker for determining the need of liver transplantation. Children with an indeterminate diagnosis were more likely to be in the high-INR group, and more likely to undergo liver transplantation as compared to other children with a specified diagnosis. The results suggest that INR was not a strong indicator for death without liver transplantation. Further studies should attempt to reveal biological mechanisms among the indeterminate diagnosis patients. This study has public health significance for its design to better understand the mechanism and progression of the children with acute liver failure from a multi-center collaboration.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Zhang, Songpmf0770@yahoo.com
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairMazumdar, Satimaz1@pitt.eduMAZ1
Committee MemberBelle, Steven sbelle@vms.cis.pitt.eduSBELLE
Committee MemberChang, Joycechangjh@upmc.edu
Committee MemberLi, Ruosharul12@pitt.eduRUL12
Date: 25 September 2012
Date Type: Completion
Defense Date: 28 June 2012
Approval Date: 25 September 2012
Submission Date: 20 July 2012
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 36
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Biostatistics
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Acute liver failure, Mixture growth modeling, Latent classes, Growth trajectory
Date Deposited: 25 Sep 2012 13:12
Last Modified: 19 Dec 2016 14:38
URI: http://d-scholarship.pitt.edu/id/eprint/13044

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  • Growth Mixture Modeling to Identify Patterns of the Development of Acute Liver Failure in Children. (deposited 25 Sep 2012 13:12) [Currently Displayed]

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