Evaluation of the Liver Injury Unit Scoring System to Predict Survival in a Multinational Study of Pediatric Acute Liver Failure
Evaluation of the Liver Injury Unit Scoring System to Predict Survival in a Multinational Study of Pediatric Acute Liver Failure
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DOI：
10.1016/j.jpeds.2012.11.021
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发表时间：
2013-05-01
影响因子：
5.1
通讯作者：
Sokol, Ronald J.
中科院分区：
文献类型：
--
作者：
Lu, Brandy R.;Zhang, Song;Sokol, Ronald J.
目的 探讨儿童急性肝衰竭 (PALF) 研究组（一项跨国前瞻性研究）的大队列中胆红素和凝血酶原时间的肝损伤单位 (LIU) 和入院值 (aLIU) 以及国际标准化比值评分的预测价值。 研究设计 分别计算 1999 年至 2008 年参加 PALF 研究的 461 名和 579 名个体的 LIU 和 aLIU 评分。使用受试者操作特征曲线来评估入组后 21 天时未进行肝移植 (LT) 的生存率、死亡或 LT 的评分。 结果 21 天时，50.3% 的参与者在未进行 LT 的情况下存活，36.2% 的参与者接受了 LT，13.4% 的死亡。基于具有国际标准化比率的 LIU 评分（95% CI，0.78-0.85），无移植生存的 c 指数为 0.81；基于 aLIU 评分（95% CI，0.72-0.79），无移植生存的 c 指数为 0.76。 LIU 评分对 LT 的预测效果优于对死亡的预测（LT 的 c 指数为 0.84，死亡的 c 指数为 0.76）。结论 根据大型多中心 PALF 患者队列的数据，LIU 评分比 aLIU 评分更能预测无移植生存。 LIU 评分可能是预测 PALF 患者临床结果的有用的动态工具。 （儿科杂志 2013；162：1010-6）。
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. (J Pediatr 2013;162:1010-6).