Comparison of pediatric liver injury unit score and King’s college hospital criteria as a predictor of outcome in children with acute liver failure
DOI:
https://doi.org/10.18203/2349-3291.ijcp20253479Keywords:
Pediatric acute liver failure, PLIU score, King’s college criteria, Prognostic model, Mortality predictionAbstract
Background: Pediatric acute liver failure (ALF) is a life-threatening condition with high morbidity and mortality, necessitating accurate prognostic tools for early risk stratification. The pediatric liver injury unit (PLIU) Score is a relatively new scoring model developed to improve mortality prediction in pediatric ALF. This study compares PLIU Score and King’s College Hospital Criteria (KCHC) in predicting clinical outcomes in pediatric ALF patients.
Methods: This prospective observational study included 28 pediatric ALF patients admitted to a tertiary care hospital in Bangladesh. Clinical and laboratory parameters were assessed at admission, and both KCHC and PLIU Scores were calculated. The primary outcome measure was survival without liver transplantation vs. mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed for both scoring systems. ROC curve analysis was performed to determine the predictive performance of PLIU Score.
Results: Among the 28 patients, 64.29% survived without liver transplantation, while 35.71% succumbed to ALF. Wilson’s disease (50% mortality) and indeterminate ALF (40% mortality) were associated with the highest fatality rates. PLIU Score >233 was significantly correlated with mortality (p=0.04), whereas KCHC showed no significant association with mortality (p=0.09). PLIU Score demonstrated higher sensitivity (80%), specificity (66.7%), PPV (57.1%), and NPV (85.7%) compared to KCHC (40%, 22.2%, 22.2%, and 40%, respectively). ROC curve analysis confirmed the superior predictive ability of PLIU (AUC=0.75) over KCHC.
Conclusion: PLIU Score outperforms KCHC in predicting mortality outcomes in pediatric ALF, offering a more reliable prognostic tool for early risk stratification. Its higher sensitivity and predictive accuracy support its potential integration into clinical practice. Future research should focus on validating PLIU Score in larger cohorts and exploring additional biomarkers to enhance its prognostic utility.
Metrics
References
Cochran JB, Losek JD. Acute liver failure in children. Pediatr Emerg Care. 2007;23(2):129–35. DOI: https://doi.org/10.1097/PEC.0b013e3180308f4b
Montrief T, Koyfman A, Long B. Acute liver failure: A review for emergency physicians. Am J Emerg Med. 2019;37(2):329–37. DOI: https://doi.org/10.1016/j.ajem.2018.10.032
Lenz D, Hørby Jørgensen M, Kelly D, Cardinale V, Geerts A, Gonçalves Costa I, et al. Etiology and Outcome of Adult and Pediatric Acute Liver Failure in Europe. J Pediatr Gastroenterol Nutr. 2023;77(1):115–20. DOI: https://doi.org/10.1097/MPG.0000000000003777
Grama A, Aldea C, Burac L, Delean D, Boghitoiu D, Bulata B, et al. Acute liver failure secondary to toxic exposure in children. Arch Med Sci. 2019;18(1):84–91. DOI: https://doi.org/10.5114/aoms.2019.87716
Bretherick AD, Craig DGN, Masterton G, Bates C, Davidson J, Martin K, et al. Acute liver failure in Scotland between 1992 and 2009; incidence, aetiology and outcome. QJM. 2011;104(11):945–56. DOI: https://doi.org/10.1093/qjmed/hcr098
Kelly DA. Managing acute liver failure. Cur Paediat. 2001;11(2):96–101. DOI: https://doi.org/10.1054/cupe.2000.0156
Hey P, Hanrahan TP, Sinclair M, Testro AG, Angus PW, Peterson A, et al. Epidemiology and outcomes of acute liver failure in Australia. World J Hepatol. 2019;11(7):586–95. DOI: https://doi.org/10.4254/wjh.v11.i7.586
Vasques F, Cavazza A, Bernal W. Acute liver failure. Curr Opin Crit Care. 2022;28(2):198–207. DOI: https://doi.org/10.1097/MCC.0000000000000923
Sundaram V, Shneider BL, Dhawan A, Ng VL, Im K, Belle S, et al. King’s College Hospital Criteria for non-acetaminophen induced acute liver failure in an international cohort of children. J Pediatr. 2013;162(2):319-23. DOI: https://doi.org/10.1016/j.jpeds.2012.07.002
McPhail MJW, Farne H, Senvar N, Wendon JA, Bernal W. Ability of King’s college criteria and model for end-stage liver disease scores to predict mortality of patients with acute liver failure: a meta-analysis. Clin Gastroenterol Hepatol. 2016;14(4):516-25. DOI: https://doi.org/10.1016/j.cgh.2015.10.007
Shakil AO, Kramer D, Mazariegos GV, Fung JJ, Rakela J. Acute liver failure: clinical features, outcome analysis, and applicability of prognostic criteria. Liver Transpl. 2000;6(2):163–9. DOI: https://doi.org/10.1002/lt.500060218
Lu BR, Zhang S, Narkewicz MR, Belle SH, Squires RH, Sokol RJ. Evaluation of the liver injury unit scoring system to predict survival in a multinational study of pediatric acute liver failure. J Pediatr. 2013;162(5):1010-6. DOI: https://doi.org/10.1016/j.jpeds.2012.11.021
Nogueira AF, Teixeira C, Fernandes C, Moinho R, Gonçalves I, Pinto CR, et al. Prognostic markers in pediatric acute liver failure. GE Port J Gastroenterol. 2024;31(3):165–72. DOI: https://doi.org/10.1159/000531269
Lu BR, Gralla J, Liu E, Dobyns EL, Narkewicz MR, Sokol RJ. Evaluation of a scoring system for assessing prognosis in pediatric acute liver failure. Clin Gastroenterol Hepatol. 2008;6(10):1140–5. DOI: https://doi.org/10.1016/j.cgh.2008.05.013
Amatya P, Kapalavai SK, Deep A, Sankaranarayanan S, Krupanandan R, Sadasivam K, et al. Pediatric acute liver failure: An experience of a pediatric intensive care unit from resource limited settings. Front Pediatr. 2022;10:956699. DOI: https://doi.org/10.3389/fped.2022.956699
Cholongitas E, Theocharidou E, Vasianopoulou P, Betrosian A, Shaw S, Patch D, et al. Comparison of the sequential organ failure assessment score with the King’s College Hospital criteria and the model for end-stage liver disease score for the prognosis of acetaminophen-induced acute liver failure. Liver Transpl. 2012;18(4):405–12. DOI: https://doi.org/10.1002/lt.23370
Bhatt H, Rao GS. Management of Acute Liver Failure: A Pediatric Perspective. Curr Pediatr Rep. 2018;6(3):246–57. DOI: https://doi.org/10.1007/s40124-018-0174-7
Dogra S, Kumar K, Malhotra S, Jerath N, Sibal A. Acute Liver Failure in Dengue: A Common but Overlooked Entity in Pediatric Patients in Tropical Countries. J Pediatr Gastroenterol Nutr. 2023;76(2):149–53. DOI: https://doi.org/10.1097/MPG.0000000000003646
Kaliciński P, Grenda R, Szymczak M, Pietraszek E, Pawłowska J. Multidisciplinary management of children with acute liver failure report on 104 children treated in single center. Pediatr Transplant. 2024;28(1):14654. DOI: https://doi.org/10.1111/petr.14654
Talat S, Khan SA, Javed N, Malik MI. Etiology, clinical presentation, and outcome of children with fulminant hepatic failure: Experience from a tertiary center in Pakistan. Pak J Med Sci. 2020;36(6):1252–6. DOI: https://doi.org/10.12669/pjms.36.6.2375
Vandriel SM, Ayoub MD, Ricciuto A, Hansen BE, Ling SC, Ng VL, et al. Pediatric Wilson disease presenting as acute liver failure: an individual patient data meta-analysis. J Pediatr Gastroenterol Nutr. 2020;71(3):90–6. DOI: https://doi.org/10.1097/MPG.0000000000002777
Mendizabal M, Dip M, Demirdjian E, Lauferman L, Lopez S, Minetto J, et al. Changing etiologies and prognostic factors in pediatric acute liver failure. Liver Transplantation. 2020;26(2):268. DOI: https://doi.org/10.1002/lt.25658
Nabi T, Rafiq N, Jamil I. Comparative study of etiological profile and outcome in acute liver failure. Int J Sci Rep. 2019;5(4):96–102. DOI: https://doi.org/10.18203/issn.2454-2156.IntJSciRep20191432
Jain V, Srivastava A, Yachha SK, Kumari N, Kathuria R, Sarma MS, et al. Autoimmune acute liver failure and seronegative autoimmune liver disease in children: Are they different from classical disease. Eur J Gastroenterol Hepatol. 2017;29(12):1408–15. DOI: https://doi.org/10.1097/MEG.0000000000000975
Grama A, Sîrbe C, Burac L, Benţa G, Bordea MA, Pop TL. Coagulation Factors as Predictive Markers of Poor Outcomes in Children with Acute Liver Failure. Clin Lab. 2022;68(8):76. DOI: https://doi.org/10.7754/Clin.Lab.2021.211105
Bravo LC, Gregorio GV, Shafi F, Bock HL, Boudville I, Liu Y, et al. Etiology, incidence and outcomes of acute hepatic failure in 0–18-year-old Filipino children. Southeast Asian J Trop Med Public Health. 2012;43(3):764–72.
Bechmann LP, Jochum C, Kocabayoglu P, Sowa JP, Kassalik M, Gieseler RK, et al. Cytokeratin 18-based modification of the MELD score improves prediction of spontaneous survival after acute liver injury. J Hepatol. 2010;53(4):639–47. DOI: https://doi.org/10.1016/j.jhep.2010.04.029
Srivastava A, Yachha SK, Poddar U. Predictors of outcome in children with acute viral hepatitis and coagulopathy. J Viral Hepat. 2012;19(2):194-201. DOI: https://doi.org/10.1111/j.1365-2893.2011.01495.x
Pop TL, Aldea CO, Delean D, Bulata B, Boghiţoiu D, Păcurar D, et al. The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure. J Clin Med. 2022;11(2):432. DOI: https://doi.org/10.3390/jcm11020432
McPhail MJW, Wendon JA, Bernal W. Meta-analysis of performance of Kings’s College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure. J Hepatol. 2010;53(3):492–9. DOI: https://doi.org/10.1016/j.jhep.2010.03.023
Downloads
Published
How to Cite
Issue
Section
