Evaluation of the PELD risk score as a severity index of biliary atresia

J Pediatr Surg. 2003 Jul;38(7):1001-4. doi: 10.1016/s0022-3468(03)00179-9.

Abstract

Purpose: 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.

Publication types

  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Biliary Atresia / physiopathology*
  • Biliary Atresia / surgery*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Liver Failure / etiology*
  • Liver Failure / surgery
  • Liver Transplantation*
  • Male
  • Prognosis
  • Severity of Illness Index*