Evaluation of the Liver Injury Unit Scoring System to Predict Survival in a Multinational Study of Pediatric Acute Liver Failure

Abstract

Objective To examine the predictive value of the Liver Injury Units (LIU) and admission values (aLIU) of bilirubin and prothrombin time and international normalized ratio scores in a large cohort from the Pediatric Acute Liver Failure (PALF) Study Group, a multinational prospective study. Study design LIU and aLIU scores were calculated for 461 and 579 individuals, respectively, enrolled in the PALF study from 1999 to 2008. Receiver operator characteristic curves were used to evaluate the scores with respect to survival without liver transplantation (LT), death, or LT by 21 days after enrollment. Results At 21 days, 50.3% of participants were alive without LT, 36.2% underwent LT, and 13.4% died. The c-indices for transplant-free survival were 0.81 based on the LIU score with the international normalized ratio (95% CI, 0.78-0.85) and 0.76 based on the aLIU score (95% CI, 0.72-0.79). The LIU score predicted LT better than it predicted death (c-index for LT 0.84, c-index for death 0.76). Conclusion Based on data from a large, multicenter cohort of patients with PALF, the LIU score was a better predictor of transplant-free survival than was the aLIU score. The LIU score might be a helpful, dynamic tool to predict clinical outcomes in patients with PALF.

Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the american association for the study of liver diseases, american society of transplantation and the north american society for pediatric gastroenterology, hepatolo

“…Outcomes vary among and between etiologies, patient age groups, and disease severity . However, children with an indeterminate diagnosis are more likely to receive a liver transplant …”

Prognostic modeling in pediatric acute liver failure

“…Lu et al subsequently validated this score internally on retrospective analysis of a subsequent group of children (n = 53). The transportability of this score to a larger, more heterogeneous population (n = 461) was assessed by application to the PALF Study database . In contrast to the preceding studies, LT and death alone were assessed as separate outcome measures in addition to the combined death/LT parameter.…”

“…Admission LIU scores were not predictive of death/LT. Lu et al sought to use the score in a dynamic way by calculating the highest daily LIU score within the 21 days of enrollment. Good discrimination for death/LT (AUROC, 0.81) was revealed on using the highest values.…”

Data-Driven Modeling for Precision Medicine in Pediatric Acute Liver Failure

“…First, patterns of inflammation and biological interactions may associate with clinical outcomes. Current models to predict death or spontaneous survival in PALF using clinical, biochemical, and demographic data are inadequate 19,20 and it is unlikely Molecular Medicine www.molmed.org…”