Pediatric Gastroenterology and Hepatology Division, Hospital Italiano Buenos Aires, Ciudad Autonoma Buenos Aires, Buenos Aires, Argentina.
J Pediatr Gastroenterol Nutr. 2012 Feb;54(2):193-6. doi: 10.1097/MPG.0b013e3182349a04.
Although establishing accurate prognosis in acute liver failure (ALF) is of paramount importance, prognostic scoring systems still fail to achieve success. The pediatric end-stage liver disease (PELD) score has been used as a predictor of mortality in children with chronic liver disease listed for liver transplantation (LT); however, experience with the PELD score in ALF is limited. The goal of the present study was to investigate the prognostic accuracy of the PELD score in children with ALF.
PELD score was calculated based on results of blood tests obtained at hospital admission from June 1999 to January 2009, in 40 consecutive patients younger than 18 years who presented with ALF. Poor outcome was defined as LT or death.
Mean (±SD) age of patients was 5.3 ± 4.4 years (range 6 months-17 years); 52.5% were girls (n = 21). Etiologies of ALF were hepatitis A in 42.5% (17), indeterminate in 35% (14), autoimmune hepatitis in 17.5% (type 1 12.5% [n5], type 2 5% [n2]), and toxic in 5% (2). Mean PELD score was 34.92 ± 10.48 (range 6-55). PELD scores obtained on admission were significantly higher among nonsurvivors (39.8 ± 9.5) and recipients of an LT (39 ± 7.1) compared with those who survived without LT (31.3 ± 3) (P < 0.001). A cutoff of 33 in PELD score using receiver operating characteristic curves showed 81% specificity and 86% sensitivity for poor outcome (positive predictive value 92% and negative predictive value 69%; area under curve 0.88 95% confidence interval 0.77-1.0; P < 0.0001).
PELD score obtained upon admission may be of help to establish the optimal timing for LT evaluation and listing. Further validation in larger and more diverse populations is needed.
尽管准确预测急性肝衰竭（ALF）的预后至关重要，但预后评分系统仍未能取得成功。小儿终末期肝病评分（PELD）已被用作预测接受肝移植（LT）的慢性肝病儿童死亡率的指标；然而，PELD 评分在 ALF 中的应用经验有限。本研究的目的是探讨 PELD 评分在 ALF 患儿中的预后准确性。
1999 年 6 月至 2009 年 1 月，40 例年龄小于 18 岁的 ALF 患儿入院时进行血液检查，计算 PELD 评分。不良预后定义为 LT 或死亡。
患者平均年龄（±标准差）为 5.3±4.4 岁（年龄范围为 6 个月至 17 岁）；52.5%为女孩（n=21）。ALF 的病因包括甲型肝炎 42.5%（17 例）、未确定病因 35%（14 例）、自身免疫性肝炎 17.5%（1 型 12.5%[n5]，2 型 5%[n2]）和中毒性肝炎 5%（2 例）。平均 PELD 评分为 34.92±10.48（范围为 6-55）。死亡组和 LT 组患者入院时的 PELD 评分显著高于未接受 LT 治疗的存活组（39.8±9.5 vs 31.3±3）（P<0.001）。使用受试者工作特征曲线确定 PELD 评分截断值为 33 时，对不良预后的特异性为 81%，敏感性为 86%（阳性预测值为 92%，阴性预测值为 69%；曲线下面积为 0.88，95%置信区间为 0.77-1.0；P<0.0001）。
入院时获得的 PELD 评分有助于确定 LT 评估和登记的最佳时机。需要在更大和更多样化的人群中进一步验证。
