gtag('event', 'click', { 'event_category': 'PDF Download' });
was successfully added to your cart.


Acute Liver FailureHealth Professionals Blog

Improved mortality prediction for pediatric acute liver failure using dynamic prediction strategy

Title: Improved mortality prediction for pediatric acute liver failure using dynamic prediction strategy

Source: Journal of Pediatric Gastroenterology and Nutrition 2024, 78 (2): 320-327

Follow this link

Date of publication: February 2024

Publication type: Article

Abstract: Objectives: To develop and validate a prediction tool for pediatric acute liver failure (PALF) mortality risks that captures the rapid and heterogeneous clinical course for accurate and updated prediction.

Methods: Data included 1144 participants with PALF enrolled during three phases of the PALF registry study over 15 years. Using joint modeling, we built a dynamic prediction tool for mortality by combining longitudinal trajectories of multiple laboratory and clinical variables. The predictive performance for 7-day and 21-day mortality was assessed using the area under curve (AUC) through cross-validation and split-by-time validation.

Results: We constructed a prognostic joint model that combines the temporal trajectories of international normalized ratio, total bilirubin, hepatic encephalopathy, platelet count, and serum creatinine. Dynamic prediction using updated information improved predictive performance over static prediction using the information at enrollment (Day 0) only. In cross-validation, AUC increased from 0.784 to 0.887 when measurements obtained between Days 1 and 2 were incorporated. AUC remained similar when we used the earlier subset of the sample for training and the later subset for testing.

Conclusions: Serial measurements of five variables in the first few days of PALF capture the dynamic clinical course of the disease and improve risk prediction for mortality. Continuous disease monitoring and updating risk prognosis are beneficial for timely and judicious medical decisions.

Leave a Reply

© 2019 Children's Liver Disease Foundation. All Rights Reserved.