Development of a Prognostic Score to Predict Mortality in Patients with Pediatric Acute Liver Failure

Development of a Prognostic Score to Predict Mortality in Patients with Pediatric Acute Liver Failure: Objectives:

This study aims to develop a new prognostic score based on changes in serial laboratory data from patients with pediatric acute liver failure (PALF).

Methods:

We retrospectively reviewed data on 146 patients with PALF at the Seoul National University Children Hospital (SNUCH) and the Asan Medical Center (AMC). Daily morning laboratory records were obtained for up to 7 days after diagnosis of PALF; (1) total bilirubin (TB) (mg/dL), international normalized ratio for prothrombin time (INR) at enrollment (2) peak TB, peak INR, peak ammonia (μmol/L) (3) a) the difference between the peak TB and TB at enrollment (i.e., Δpeak TB), b) the difference between the peak INR and INR at enrollment (i.e., Δpeak INR), c) the maximum change in serial TB (i.e., Δdaily TB), d) the maximum change in serial INR level (i.e., Δdaily INR). We assigned non-transplanted patients in SNUCH and AMC to derivation and validation cohorts, respectively.

Results:

Δpeak TB, Δdaily TB, Δpeak INR and Δdaily INR were significantly higher in the non-survival group. We developed a new score that can predict mortality in non-transplanted patients (derivation cohort n=42, validation cohort n = 33). PALF-Delta score (PALF-Ds) = [0.232 × Δpeak TB (mg/dL)] + [2.263 × Δdaily INR] + [0.013 × peak ammonia (μmol/L)] - 4.498. The score yielded AUC 0.918 in the derivation cohort (sensitivity 81%, specificity 91%) and AUC 0.947 in the validation cohort (sensitivity 100%, specificity 89%).

Conclusions:

A prognostic scoring system using the change of TB/INR may be useful for predicting mortality in patients with PALF.

Address correspondence and reprint requests to Jae Sung Ko, MD, Professor of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (e-mail: kojs@snu.ac.kr).

Received 26 July, 2019

Accepted 22 December, 2019

None of the authors has any relevant financial relationships to disclose or conflicts of interest to we solve.

© 2020 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,