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Pediatric End-stage Liver Disease Score in Acute Liver Failure to Assess Poor Prognosis

Sanchez, Maria C.; D’Agostino, Daniel E.

Journal of Pediatric Gastroenterology & Nutrition: February 2012 - Volume 54 - Issue 2 - p 193–196
doi: 10.1097/MPG.0b013e3182349a04
Original Articles: Hepatology and Nutrition

Background and Aim: Although establishing accurate prognosis in acute liver failure (ALF) is of paramount importance, prognostic scoring systems still fail to achieve success. The pediatric end-stage liver disease (PELD) score has been used as a predictor of mortality in children with chronic liver disease listed for liver transplantation (LT); however, experience with the PELD score in ALF is limited. The goal of the present study was to investigate the prognostic accuracy of the PELD score in children with ALF.

Patients and Methods: PELD score was calculated based on results of blood tests obtained at hospital admission from June 1999 to January 2009, in 40 consecutive patients younger than 18 years who presented with ALF. Poor outcome was defined as LT or death.

Results: Mean (±SD) age of patients was 5.3 ± 4.4 years (range 6 months–17 years); 52.5% were girls (n = 21). Etiologies of ALF were hepatitis A in 42.5% (17), indeterminate in 35% (14), autoimmune hepatitis in 17.5% (type 1 12.5% [n5], type 2 5% [n2]), and toxic in 5% (2). Mean PELD score was 34.92 ± 10.48 (range 6–55). PELD scores obtained on admission were significantly higher among nonsurvivors (39.8 ± 9.5) and recipients of an LT (39 ± 7.1) compared with those who survived without LT (31.3 ± 3) (P < 0.001). A cutoff of 33 in PELD score using receiver operating characteristic curves showed 81% specificity and 86% sensitivity for poor outcome (positive predictive value 92% and negative predictive value 69%; area under curve 0.88 95% confidence interval 0.77–1.0; P < 0.0001).

Conclusions: PELD score obtained upon admission may be of help to establish the optimal timing for LT evaluation and listing. Further validation in larger and more diverse populations is needed.

Pediatric Gastroenterology and Hepatology Division, Hospital Italiano Buenos Aires, Ciudad Autonoma Buenos Aires, Buenos Aires, Argentina.

Address correspondence and reprint requests to Maria C. Sanchez, MD, Hospital Italiano Buenos Aires, Ciudad Autonoma Buenos Aires, Buenos Aires, Argentina (e-mail:

Received 7 April, 2011

Accepted 25 August, 2011

The authors report no conflict of interest.

Copyright 2012 by ESPGHAN and NASPGHAN