Improved Mortality Prediction for Pediatric Acute Liver Failure Using Dynamic Prediction Strategy

Authors

Ruosha Li
Jingyan Wang
Cuihong Zhang
James E Squires
Steven H Belle
Jing Ning
Jianwen Cai
Robert H Squires

Publication Date

2-1-2024

Journal

Journal of Pediatric Gastroenterology and Nutrition

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.

Keywords

Child, Humans, Liver Failure, Acute, Prognosis, Hepatic Encephalopathy, Bilirubin, Disease Progression, joint model, multiple variable trajectories, PALF, validation

DOI

10.1002/jpn3.12094

PMID

38374548

PMCID

PMC10879686

PubMedCentral® Posted Date

2-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes