Pediatric end-stage liver disease
Encyclopedia
Pediatric end-stage liver disease (PELD) is a disease severity scoring system for children under 12 years of age. It is calculated from the patient's albumin
, bilirubin
, and international normalized ratio (INR) together with the patient's age and degree of growth failure. This score is also used by the United Network for Organ Sharing
(UNOS) for prioritizing allocation of liver transplants
.
, serum albumin
, the international normalized ratio for prothrombin time (INR)
, whether the patient is less than 1 year old, and whether the patient has growth failure (<-2 standard deviation) to predict survival. It is calculated according to the following formula:
Human serum albumin
Human serum albumin is the most abundant protein in human blood plasma. It is produced in the liver. Albumin constitutes about half of the blood serum protein...
, bilirubin
Bilirubin
Bilirubin is the yellow breakdown product of normal heme catabolism. Heme is found in hemoglobin, a principal component of red blood cells. Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases...
, and international normalized ratio (INR) together with the patient's age and degree of growth failure. This score is also used by the United Network for Organ Sharing
United Network for Organ Sharing
Located in Richmond, Virginia, the United Network for Organ Sharing is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network in the United States, established by the U.S. Congress in 1984.UNOS was awarded the initial OPTN...
(UNOS) for prioritizing allocation of liver transplants
Liver transplantation
Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original...
.
Determination
PELD uses the patient's values for serum bilirubinBilirubin
Bilirubin is the yellow breakdown product of normal heme catabolism. Heme is found in hemoglobin, a principal component of red blood cells. Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases...
, serum albumin
Albumin
Albumin refers generally to any protein that is water soluble, which is moderately soluble in concentrated salt solutions, and experiences heat denaturation. They are commonly found in blood plasma, and are unique to other blood proteins in that they are not glycosylated...
, the international normalized ratio for prothrombin time (INR)
Prothrombin time
The prothrombin time and its derived measures of prothrombin ratio and international normalized ratio are measures of the extrinsic pathway of coagulation. This test is also called "ProTime INR" and "INR PT". They are used to determine the clotting tendency of blood, in the measure of warfarin...
, whether the patient is less than 1 year old, and whether the patient has growth failure (<-2 standard deviation) to predict survival. It is calculated according to the following formula:
- PELD = 4.80[Ln serum bilirubin (mg/dL)] + 18.57[Ln INR] - 6.87[Ln albumin (g/dL)] + 4.36(<1 year old) + 6.67(growth failure)