title: Evaluation of the liver injury unit scoring system to predict survival in a multinational study of pediatric acute liver failure.
abstract: OBJECTIVE
  To examine the predictive value of the Liver Injury Units (LIU) and admission values (aLIU) of bilirubin and prothrombin time and international normalized ratio scores in a large cohort from the Pediatric Acute Liver Failure (PALF) Study Group, a multinational prospective study.
  
  
  METHODS
  LIU and aLIU scores were calculated for 461 and 579 individuals, respectively, enrolled in the PALF study from 1999 to 2008. Receiver operator characteristic curves were used to evaluate the scores with respect to survival without liver transplantation (LT), death, or LT by 21 days after enrollment.
  
  
  RESULTS
  At 21 days, 50.3% of participants were alive without LT, 36.2% underwent LT, and 13.4% died. The c-indices for transplant-free survival were 0.81 based on the LIU score with the international normalized ratio (95% CI, 0.78-0.85) and 0.76 based on the aLIU score (95% CI, 0.72-0.79). The LIU score predicted LT better than it predicted death (c-index for LT 0.84, c-index for death 0.76).
  
  
  CONCLUSIONS
  Based on data from a large, multicenter cohort of patients with PALF, the LIU score was a better predictor of transplant-free survival than was the aLIU score. The LIU score might be a helpful, dynamic tool to predict clinical outcomes in patients with PALF.
authors.affiliation: Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Brandy R
authors.initials: BR
authors.lastname: Lu
authors.forename: Song
authors.initials: S
authors.lastname: Zhang
authors.forename: Michael R
authors.initials: MR
authors.lastname: Narkewicz
authors.forename: Steven H
authors.initials: SH
authors.lastname: Belle
authors.forename: Robert H
authors.initials: RH
authors.lastname: Squires
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sokol
mesh_terms: D000293:Adolescent; D001663:Bilirubin; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D008099:Liver / Q000503:physiopathology*; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000401:mortality; D016031:Liver Transplantation; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011517:Prothrombin Time; D012107:Research Design; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D001663:Bilirubin