Predicting liver failure in parenteral nutrition-dependent short bowel syndrome of infancy.
OBJECTIVE
To test the hypothesis that early trends in common blood tests may delineate risks of liver failure (LF) in infants with parenteral nutrition-associated liver disease (PNALD) from short bowel syndrome and suggest criteria for transplant referral.


METHODS
Total levels of bilirubin, gamma-glutamyl transferase, albumin, alanine aminotransferase, platelet count, and absolute neutrophil count were recorded every 3 months for 61 infants with PNALD who were being considered for intestinal transplant starting at age 3 months until death without transplant (n = 12), LF with transplant (n = 35), or liver recovery without transplant (n = 14). Probabilities of LF were determined with logistic regression.


RESULTS
Independent predictors of LF were, in descending order, total bilirubin level (odds ratio [OR] = 1.195), platelet count (OR = 0.992), and albumin level (OR = 0.248). Predicted probabilities of eventual LF varied from 36% to 38% at ages 3 to 6 months when the total bilirubin level was 6.0 mg/dL, platelet count was 220 x 10(3)/microL, and albumin level was 3.5 g/dL to 83% to 84% when the total bilirubin level was 11.7 mg/dL, platelet count was 168 x 10(3)/microL, and albumin level was 3.0 g/dL.


CONCLUSIONS
Transplant referral for a total bilirubin level of 6 mg/dL between 3 to 6 months of age is appropriate, because the probability of LF is at least 36%.
Kaufman
Stuart S
SS
Department of Pediatrics, Georgetown University School of Medicine, Institute of Transplantation, Georgetown University Hospital, Washington, DC 20007, USA. SSK27@gunet.georgetown.edu
Pehlivanova
Marieta
M
Fennelly
Erin M
EM
Rekhtman
Yuliya M
YM
Gondolesi
Gabriel E
GE
Little
Cheryl A
CA
Matsumoto
Cal S
CS
Fishbein
Thomas M
TM
D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications / Q000628:therapy*; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D001663:Bilirubin