Lee et al reported a score predictive of mortality for a pediatric patient with acute liver failure (PALF). This can help to identify a patient who may benefit from more aggressive therapy including liver transplantation. The authors are from Seoul National University Children's Hospital, Asan Medical Center Children's Hospital, and University of Ulsan in Korea.
Patient selection: pediatric patient with acute liver failure (PALF)
Parameters:
(1) delta peak serum total bilirubin in mg/dL (difference between peak and concentration at enrollment)
(2) delta daily INR (maximum change in serial INR)
(3) peak serum ammonia in µmol/L
Parameter
Points
delta peak total bilirubin
0.232 * (delta peak TB)
delta daily INR
2.263 * (delta daily INR)
peak ammonia
0.013 * (max ammonia)
PALF delta score =
= SUM(points for all of the parameters) - 4.498
Since the delta score is based on the beta-coefficients from logistic regression, then it is assumed that:
probability of death =
= 1 / (1 + EXP((-1) * (PALF delta score)))
Performance:
• The area under the ROC curve is 0.92.
• Care needs to be taken in collecting and testing specimens for serum ammonia to ensure accurate results.
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