Study of predictive value of pediatric risk of mortality (PRISM) score in children with end stage liver disease and fulminant hepatic failure.
OBJECTIVE
To evaluate the use of the PRISM score as a predictor of outcome in patients with end stage liver disease (ESLD) and fulminant hepatic failure (FHF).


METHODS
The present study included 30 patients with ESLD and FHF, with ages ranging from 2 to 108 months, who were admitted to the Emergency room (ER) and the Pediatric Hepatology Unit at Cairo University Children's Hospital (tertiary referral hospital) over a six-month-period from May through October 2008. Survivors were followed up for 6 months. Two other scores were also calculated, the PELD score and the Child-Pugh score. The outcome was defined as survivors and deceased.


RESULTS
Deceased patients as compared with survivors were significantly younger (median age 7 vs. 24 months, p=0.003). A ROC curve was constructed for the PRISM score, the predicted death rate (PDR) and the PELD score in the 30 patients. PRISM score was significantly associated with mortality (p=0.04). The best cut off value was 9.5 (70.6% sensitive and 61% specific). PDR was also significantly associated with mortality (p=0.011). The best cut off value for PDR was 5.95 (70.6% sensitive, 85% specific). On the other hand, the PELD score was not associated with mortality (p=0.202).


CONCLUSIONS
PRISM score can be applied with an adequate degree of accuracy for severity assessment and mortality prediction to pediatric patients with ESLD or FHF.
El-Karaksy
Hanaa M
HM
Department of Pediatrics, Cairo University, Cairo, Egypt. hanaakaraksy@yahoo.com
El-Shabrawi
Mortada M
MM
Mohsen
Nabil A
NA
El-Koofy
Nehal M
NM
El-Akel
Wafaa A
WA
Fahmy
Mona E
ME
Yassin
Noha A
NA
D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D016019:Survival Analysis