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. 2008 Oct;6(10):1140-5.
doi: 10.1016/j.cgh.2008.05.013.

Evaluation of a scoring system for assessing prognosis in pediatric acute liver failure

Brandy R Lu  1 , Jane Gralla, Edwin Liu, Emily L Dobyns, Michael R Narkewicz, Ronald J Sokol
Affiliations

Evaluation of a scoring system for assessing prognosis in pediatric acute liver failure

Brandy R Lu et al. Clin Gastroenterol Hepatol. 2008 Oct.

Abstract

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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Figures

Figure 1
Figure 1. Validation of the Liver Injury Units (LIU) score using INR
(A) Survival without liver transplantation stratified by quartiles developed on the previously defined training set. LIU = 3.507 * peak total bilirubin (mg/dl) + 45.51 * peak INR + 0.254 * peak ammonia (umol/L). A low risk of death or liver transplantation (LIU score < 209) and a high risk of death or liver transplantation (LIU score ≥370) can be defined. (B) ROC curves for predicting death or liver transplantation at 4 weeks using the LIU score. A C index > 85 is considered predictive. The C index was 86.3 (95% CI 75.6 – 97.4).
Figure 2
Figure 2. Validation of the Liver Injury Units (LIU) score using PT
(A) Survival without liver transplantation stratified by quartiles developed on the previously defined training set. LIU = 3.584 * peak total bilirubin (mg/dl) + 1.809 * peak PT (seconds) + 0.307 * peak ammonia (umol/L). A low risk of death or liver transplantation (LIU score < 152) and a high risk of death or liver transplantation (LIU score ≥228) can be defined. (B) ROC curve for predicting death or liver transplantation at 4 weeks using the LIU score. The C index was 80.6 (95% CI 65.7 – 95.3).
Figure 3
Figure 3. Derivation of the admission Liver Injury Units (aLIU) score using INR
(A) Survival without liver transplantation stratified by quartiles developed using the newly derived aLIU score. aLIU = 8.4 * admission bilirubin (mg/dl) + 50.0 * admission INR. A low risk of death or liver transplantation (aLIU < 310) and a high risk of death or liver transplantation (aLIU ≥ 310) can be defined based on admission values. (B) ROC curve for predicting death or liver transplantation at 4 weeks using the aLIU score. The C index was 83.7 (95% CI 71.8 – 95.9).
Figure 4
Figure 4. Derivation of the admission Liver Injury Units (aLIU) score using PT
(A) Survival without liver transplantation stratified by quartiles developed using the newly derived aLIU score. aLIU = 6.9 * admission bilirubin (mg/dl) + 4.0 * admission PT. A low risk of death or liver transplantation (aLIU < 233) and a high risk of death or liver transplantation (aLIU ≥ 233) can be defined based on admission values. (B) ROC curve for predicting death or liver transplantation at 4 weeks using the aLIU score. The C index was 78.9 (95% CI 64.3 – 93.6).
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