This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
In a child with active liver failure, the most important prognosis factor for death is – 
Select and explain. 
A. Increasing transaminases, B. Increasing bilirubin, C. Increasing prothrombin time, D. Gram (–)ve sepsis
D: Gram (–)ve sepsis
Answer: D: Gram (–)ve sepsis 
Explanation: Prognosis of hepatic failure in children 

Children with hepatic failure have somewhat better prognosis.
The prognosis varies considerably with -

i) Cause of liver failure
ii) Stage of hepatic encephalopathy

Poor prognostic factors for mortality


If cause of liver failure is         —>       Wilson disease, idiopathic
Stage IV coma —> Most common cause of death is brain stem herniation
Age < I year
Sepsis
Severe hemorrhage
Renal failure
, Need for dialysis before transplantation

For option b & c -
"Pretransplant serum bilirubin concentration and the INR (prothrombin time) of coagulation are not predictive of post transplant survival".