Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine.
Departments of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, Korea.
J Pediatr Gastroenterol Nutr. 2020 Jun;70(6):777-782. doi: 10.1097/MPG.0000000000002625.
This study aims to develop a new prognostic score based on changes in serial laboratory data from patients with pediatric acute liver failure (PALF).
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: total bilirubin (TB) (mg/dL), international normalized ratio for prothrombin time (INR) at enrolment; peak TB, peak INR, peak ammonia (μmol/L); the difference between the peak TB and TB at enrollment (ie, Δpeak TB), the difference between the peak INR and INR at enrollment (ie, Δpeak INR), the maximum change in serial TB (ie, Δdaily TB), the maximum change in serial INR level (ie, Δdaily INR). We assigned nontransplanted patients in SNUCH and AMC to derivation and validation cohorts, respectively.
Δpeak TB, Δdaily TB, Δpeak INR, and Δdaily INR were significantly higher in the nonsurvival group. We developed a new score that can predict mortality in nontransplanted 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%).
A prognostic scoring system using the change of TB/INR may be useful for predicting mortality in patients with PALF.
本研究旨在基于儿科急性肝衰竭（PALF）患者的连续实验室数据变化，开发一种新的预后评分系统。
我们回顾性分析了首尔国立大学儿童医院（SNUCH）和 Asan 医疗中心（AMC）的 146 例 PALF 患者的数据。PALF 诊断后，我们每天早上采集最多 7 天的实验室记录：总胆红素（TB）（mg/dL），入院时国际标准化比值（INR）；TB 峰值、INR 峰值、血氨峰值（μmol/L）；TB 峰值与入院时 TB 差值（即Δpeak TB）、INR 峰值与入院时 INR 差值（即Δpeak INR）、TB 连续变化最大值（即Δdaily TB）、INR 连续变化最大值（即Δdaily INR）。我们将 SNUCH 和 AMC 的未移植患者分别分配到推导队列和验证队列。
非存活组的Δpeak TB、Δdaily TB、Δpeak INR 和Δdaily INR 显著更高。我们开发了一种可预测未移植患者死亡率的新评分（推导队列 n=42，验证队列 n=33）。PALF-Delta 评分（PALF-Ds）=[0.232×Δpeak TB（mg/dL）]+[2.263×Δdaily INR]+[0.013×peak 血氨（μmol/L）]-4.498。该评分在推导队列中的 AUC 为 0.918（敏感性 81%，特异性 91%），在验证队列中的 AUC 为 0.947（敏感性 100%，特异性 89%）。
使用 TB/INR 变化的预后评分系统可能有助于预测 PALF 患者的死亡率。
