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Evaluation of a scoring system for assessing prognosis in pediatric acute liver failure
Brandy R Lu1, Jane Gralla, Edwin Liu
1Department of Pediatrics, The Children's Hospital, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA.
Insights
The Liver Injury Units (LIU) score effectively predicts outcomes in pediatric acute liver failure (PALF). A new admission LIU (aLIU) score also shows promise for predicting death or liver transplantation in these children.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Critical Care Medicine
Background:
- Pediatric acute liver failure (PALF) carries a high risk of mortality or liver transplantation (LT).
- A previously developed Liver Injury Units (LIU) score utilizes peak bilirubin, prothrombin time/international normalized ratio, and ammonia levels to predict outcomes.
- This study aimed to validate the LIU score and develop an admission-based LIU (aLIU) score for PALF patients.
Purpose of the Study:
- To validate the predictive accuracy of the established Liver Injury Units (LIU) score in a new cohort of pediatric acute liver failure patients.
- To derive and evaluate a novel admission-based Liver Injury Units (aLIU) score for predicting outcomes in PALF.
- To assess the utility of these scores in identifying patients at high risk for death or liver transplantation.
Main Methods:
- Retrospective analysis of data from 53 children admitted with PALF between 2002 and 2006.
- Outcome assessment at 16 weeks, categorizing patients as alive without LT, deceased, or having undergone LT.
- Derivation of the aLIU score using admission values of total bilirubin and prothrombin time/international normalized ratio.
Main Results:
- The original LIU score demonstrated significant predictive value for survival without LT across quartiles (92% to 12%, P < .001) with a C-index of 86.3 for predicting death/LT by 4 weeks.
- The derived aLIU score also showed significant predictive capability, with survival rates ranging from 85% to 31% across quartiles (P = .001) and a C-index of 83.7.
- Both scores effectively differentiated patient outcomes, highlighting their clinical relevance.
Conclusions:
- The original Liver Injury Units (LIU) score is confirmed as a valid predictor of outcomes in pediatric acute liver failure.
- The newly derived admission LIU (aLIU) score shows promising predictive value and warrants further validation in independent patient cohorts.
- These scoring systems can aid in clinical decision-making and risk stratification for PALF patients.
Background & Aims:
Pediatric acute liver failure (PALF) results in death or need for liver transplantation (LT) in up to 50% of patients. A scoring system for predicting death or LT (Liver Injury Units [LIU] score) in PALF was previously derived by our group, and used peak values during hospital admission of total bilirubin, prothrombin time/international normalized ratio, and ammonia as significant predictors of outcome. The aims of this study were to test the predictive value of the LIU score in a subsequent validation set of patients and to derive a hospital admission LIU (aLIU) score predictive of outcome.
Methods:
Data were obtained from 53 children admitted with PALF from 2002 to 2006. Outcome was defined at 16 weeks as alive without LT, death, or LT.
Results:
Survival without LT at 16 weeks for each LIU score quartile was 92%, 44%, 60%, and 12%, respectively (P < .001). The receiver operating characteristic C index for predicting death or LT by 4 weeks was 86.3. An admission LIU score was derived using admission total bilirubin and prothrombin time/international normalized ratio. Survival without LT at 16 weeks for each quartile using the aLIU score was 85%, 77%, 69%, and 31% (P = .001). The receiver operating characteristic C index for predicting death or LT by 4 weeks was 83.7.
Conclusions:
The original LIU score is a valid predictor of outcome in PALF. The aLIU score is promising and needs to be validated in subsequent patients.
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