3 years ago

Pediatric CLIF-SOFA score is the best predictor of 28-day mortality in children with decompensated chronic liver disease

Pediatric CLIF-SOFA score is the best predictor of 28-day mortality in children with decompensated chronic liver disease
Early identification of children with decompensated chronic liver disease (DCLD) at risk of short-term mortality helps improve outcome. We evaluated the predictors of outcome and role of Child Pugh [CP], Pediatric End- stage Liver Disease [PELD] and pediatric chronic liver failure sequential organ failure assessment [pCLIF-SOFA] score in prognosticating 28 days mortality in DCLD children. Methods DCLD children were prospectively evaluated with a clinico-laboratory proforma and followed till 28 days to determine outcome. CP, PELD and pCLIF–SOFA were calculated at admission. Univariate and multivariate analysis was done to identify predictors of outcome. Results 110 children (74 boys, 96(4–204) months) were enrolled and 37(33.6%) died at 28 days. Significant risk factors for mortality were a higher International normalized ratio [INR, HR 1.17(1.04 – 1.31)] and bilirubin [HR 1.04(1.01 – 1.08)], lower albumin [HR 0.46 (0.27 – 0.77)] and sodium [HR 0.93(0.89 - 0.98)], absence of treatable etiology [HR 2.00(1.40 – 2.87)] and presence of organ failure [OF, HR 3.22(1.98 – 10.58)]. OF and serum sodium were independent predictors of poor outcome on multivariate analysis. pCLIF- SOFA [16(9–22) vs. 9(5-15)], CP [11(9–15) vs. 10(8–14)] and PELD [22.2(7.5–45.3) vs. 15.3(4.5-23.9)] scores were significantly higher in non–survivors. The area under curve of pCLIF-SOFA was 0.977, followed by CP (0.815) and PELD (0.741) score. pCLIF-SOFA score of ≥11, identified 28-day mortality with sensitivity and specificity of 94.9% and 91.5% respectively. Conclusion 34% children with DCLD have a poor short-term outcome. OF and serum sodium are independent predictors of outcome. pCLIF-SOFA performs better than CP and PELD in prognostication of 28 days mortality. Lay Summary The ability to predict the course of a disease is an important part of the assessment and helps in taking timely measures to improve the outcome. We evaluated the outcome (death vs. survival) and compared three different scoring systems in their ability to predict mortality within 28 days in children with decompensated chronic liver disease (DCLD). One third of children with DCLD died within 28 days and the pediatric chronic liver failure sequential organ failure assessment score (pCLIF–SOFA), which takes into account the main organ systems of the body (lungs, liver, brain, kidney, blood and cardiac) fared better than the Child Pugh [CP] and Pediatric End- stage Liver Disease [PELD] score which comprise of only liver related parameters in identifying children with a poor outcome. Our study supports the use of scores based on organ failure in prognosticating children with DCLD.

Publisher URL: www.sciencedirect.com/science

DOI: S0168827817323486

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