title: The pediatric risk of mortality score in infants and children with fulminant liver failure.
abstract: The pediatric risk of mortality (PRISM) score as a severity scoring system has never been assessed in infants and children with fulminant liver failure (FLF). A retrospective case study of 109 infants and children admitted in a 22-bed pediatric and neonatal intensive care unit of a tertiary university hospital, National Referral Center for Pediatric Liver Transplantation, from March 1986 to August 1997 was carried out. PRISM score was not significantly different within etiologic FLF categories, or between infants and children. However, PRISM score (mean +/- SD) showed significant difference (p = 0.001) between the 27 patients who spontaneously recovered with supportive care (8.8 +/- 5.0) and 82 patients who underwent emergency liver transplantation (ELT) or those who died before (14.9 +/- 7.7). PRISM score-based probability of mortality was underestimated when compared with observed mortality. A death probability higher than 20% had a 24% sensitivity and 95% specificity for severe outcome. Reciever operating characteristic curve for PRISM score showed elevated discriminative power (Az = 0.91) for discerning children with severe outcome from those who spontaneously recovered with supportive care. A PRISM score more than 10 showed an odds ratio of 2.69 for predicting severe outcome (95% CI: 1.11-6.55; p = 0.038). In conclusion, the PRISM score is an accurate means of severity assessment in pediatric FLF. However, PRISM score-based mortality was of low predictive value.
authors.affiliation: Unité de Soins Intensifs, Département de Pédiatrie, Hôpital de Bicêtre, 94275 Le Kremlin-Bicêtre, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tissières
authors.forename: Walter
authors.initials: W
authors.lastname: Prontera
authors.forename: Laurent
authors.initials: L
authors.lastname: Chevret
authors.forename: Denis
authors.initials: D
authors.lastname: Devictor
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate