Elsevier

The Journal of Pediatrics

Volume 162, Issue 5, May 2013, Pages 1010-1016.e4
The Journal of Pediatrics

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

Portions of this study were presented as a poster at the American Association of Liver Diseases Annual Meeting in October 30-November 3, 2009.
https://doi.org/10.1016/j.jpeds.2012.11.021Get rights and content

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.

Section snippets

Methods

Enrollment in the PALF study cohort began in December 1999. The PALF study protocol has been described in detail.2 Institutional review board approval was secured at each of the 24 clinical sites. Briefly, after informed consent was provided, demographic, clinical, and laboratory information was recorded daily on case report forms for up to 7 days after enrollment, and outcome was assessed at 21 days.2 Diagnostic evaluation and medical management were consistent with the standard of care at

Results

From December 1999 through October 2008, the PALF Study Group registry included 709 participants, of whom 461 had data available for calculating the LIU score and 579 had data for calculating the aLIU score (excluding those from University of Colorado/The Children's Hospital of Denver). Causes of PALF in the group with calculated LIU scores were indeterminate (49.9%), acetaminophen toxicity (12.8%), metabolic disease (8.7%), infection (6.7%), autoimmune liver disease (5.2%), and other (16.7%).

Discussion

In this study, using a large multicenter multinational cohort of children with PALF, the LIU score was shown to be strongly predictive of transplant-free survival (c-index 0.81). The aLIU score showed moderate predictive strength (c-index 0.76) at time of enrollment in the PALF Study, similar to the previous study.4 The weaker predictive ability of the aLIU score is likely a reflection of the variable time interval between onset of symptoms and admission and the wide spectrum of severity of

References (15)

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Cited by (0)

PALF Study Group is supported by National Institutes of Health (NIH; U01 DK072146) and University of Colorado Denver Colorado Clinical and Translational Sciences Institute (UL1 TR000154). B.L. is supported by NIH (1 T32 DK067009-01). The authors declare no conflicts of interest.

∗

List of members of the PALF Study Group is available at www.jpeds.com (Appendix).

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