Sue V McDiarmid1, Ravinder Anand, Anne S Lindblad. 1. University of California-Los Angeles Medical Center, Los Angeles, California; and EMMES Corporation, Rockville, Maryland, USA. smcdiarmid@mednet.ucla.edu.
Abstract
BACKGROUND: A pediatric end-stage liver disease (PELD) score for children with chronic liver disease using easily obtainable, objective, verifiable parameters, would be useful to prioritize children awaiting liver transplantation. METHODS: Data from the Studies of Pediatric Liver Transplantation (SPLIT), a consortium of 29 U.S. and Canadian centers, were used to develop the PELD score. Two pretransplantation endpoints were evaluated: (1) death, n=884; and (2) death or moving to the intensive care unit (ICU), n=779. The analyses were restricted to children with chronic liver disease who were listed for a first transplant. Preliminary analyses of 17 possible factors yielded 6 parameters of interest: age <1 year, total bilirubin, international normalized ratio (INR), albumin, growth failure (height or weight Z score <-2), and calculated glomerular filtration rate. In a univariate Cox regression analysis, age, bilirubin, INR, and albumin were significant (P<0.01) predictors of both endpoints; glomerular filtration rate was not significant for either endpoint; and growth failure was significant for death/ICU but not death alone. In the multivariate analyses, age, bilirubin, and INR were significant for the death endpoint; and bilirubin, INR, growth failure, and albumin were significant for the death/ICU endpoint. From these results, three PELD models were evaluated to predict both outcomes at 3 and 6 months: PELD 1 (age, bilirubin, INR); PELD 2 (bilirubin, INR, albumin, growth failure); and PELD 3 (bilirubin, INR, albumin, growth failure, and age). The area under the receiver operating characteristic curve (AUC ROC) was used to compare models. For PELD 3, the most inclusive model, the AUC ROC at 3 months was 0.92 for death and 0.82 for "death-moved to ICU." A comparison of the AUC ROCs for the other models and for the model of end-stage liver disease ([MELD], the adult end-stage liver disease severity score model), none of which performed better than PELD 3, are presented. CONCLUSION: A model using five objective parameters can accurately predict death or death-moved to ICU in children awaiting liver transplantation.
BACKGROUND: A pediatric end-stage liver disease (PELD) score for children with chronic liver disease using easily obtainable, objective, verifiable parameters, would be useful to prioritize children awaiting liver transplantation. METHODS: Data from the Studies of Pediatric Liver Transplantation (SPLIT), a consortium of 29 U.S. and Canadian centers, were used to develop the PELD score. Two pretransplantation endpoints were evaluated: (1) death, n=884; and (2) death or moving to the intensive care unit (ICU), n=779. The analyses were restricted to children with chronic liver disease who were listed for a first transplant. Preliminary analyses of 17 possible factors yielded 6 parameters of interest: age <1 year, total bilirubin, international normalized ratio (INR), albumin, growth failure (height or weight Z score <-2), and calculated glomerular filtration rate. In a univariate Cox regression analysis, age, bilirubin, INR, and albumin were significant (P<0.01) predictors of both endpoints; glomerular filtration rate was not significant for either endpoint; and growth failure was significant for death/ICU but not death alone. In the multivariate analyses, age, bilirubin, and INR were significant for the death endpoint; and bilirubin, INR, growth failure, and albumin were significant for the death/ICU endpoint. From these results, three PELD models were evaluated to predict both outcomes at 3 and 6 months: PELD 1 (age, bilirubin, INR); PELD 2 (bilirubin, INR, albumin, growth failure); and PELD 3 (bilirubin, INR, albumin, growth failure, and age). The area under the receiver operating characteristic curve (AUC ROC) was used to compare models. For PELD 3, the most inclusive model, the AUC ROC at 3 months was 0.92 for death and 0.82 for "death-moved to ICU." A comparison of the AUC ROCs for the other models and for the model of end-stage liver disease ([MELD], the adult end-stage liver disease severity score model), none of which performed better than PELD 3, are presented. CONCLUSION: A model using five objective parameters can accurately predict death or death-moved to ICU in children awaiting liver transplantation.
Authors: Agostino Colli; Juan Cristóbal Gana; Jason Yap; Thomasin Adams-Webber; Natalie Rashkovan; Simon C Ling; Giovanni Casazza Journal: Cochrane Database Syst Rev Date: 2017-04-26
Authors: Douglas B Mogul; Xun Luo; Jacqueline Garonzik-Wang; Mary G Bowring; Allan B Massie; Kathleen B Schwarz; Andrew M Cameron; John F P Bridges; Dorry L Segev Journal: Liver Transpl Date: 2019-01 Impact factor: 5.799
Authors: J M Smith; S W Biggins; D G Haselby; W R Kim; J Wedd; K Lamb; B Thompson; D L Segev; S Gustafson; R Kandaswamy; P G Stock; A J Matas; C J Samana; E F Sleeman; D Stewart; A Harper; E Edwards; J J Snyder; B L Kasiske; A K Israni Journal: Am J Transplant Date: 2012-11-16 Impact factor: 8.086