Evaluation of the PELD risk score as a severity index of biliary atresia.
OBJECTIVE
The authors evaluated the validity of the Pediatric End-Stage Liver Disease (PELD) Risk Scoring System as a severity index for patients with biliary atresia.


METHODS
Individual hospital records of 104 patients with biliary atresia were reviewed at our institution and divided into 3 groups: nontransplant survivors (n = 61), nontransplant deaths (n = 17), and transplant patients (n = 26). PELD risk scores were calculated according to Wiesner et al, multiplied by 10, and rounded to the nearest integer, as is done in determining model of end-stage liver disease (MELD) scores.


RESULTS
The PELD scores showed a significant difference between nontransplant survivors (range, -21 to 15) and dying nontransplant patients during their last few months of life (range, 2 to 40). No survivors except those below the age of one year recorded scores above 10. Transplant patients had higher scores (range, -5 to 37) before transplantation than nontransplant survivors. However, the scores were not elevated in elderly patients with intractable cholangitis, fulminant variceal rupture, and hepatopulmonary syndrome.


CONCLUSIONS
PELD profiling is a useful scoring system for selecting patients with the most severe liver dysfunction caused by biliary atresia. However, we advise caution in using this system for patients under the age of 1 year and for older patients with long-term complications.
Shinkai
Masato
M
Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
Ohhama
Youkatsu
Y
Take
Hiroshi
H
Fukuzato
Yoshimitsu
Y
Fujita
Shogo
S
Nishi
Toshiji
T
D000293:Adolescent; D000328:Adult; D001656:Biliary Atresia / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000209:etiology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index