PELD Score Calculator

How does this PELD score calculator work?

This health tool evaluates liver disease severity and prognostic in children under 12 and offers a score to be used in the stratification of each case awaiting transplant.

The PELD score calculator uses the following patient determinations in the assessment:

■ Age – important factor, especially taking in consideration whether the patient has been put on the waiting list before the age of 1. The PELD model is only suitable for patients under 12, for older patients use the MELD calculator.

■ Bilirubin – measured in mg/dL, blood test result monitoring the liver condition.

■ Albumin – measured in g/dL, serum albumin test, another blood test evaluating the essential protein, often low in people with severe chronic liver disease.

■ INR – International Normalized Ratio for prothrombin time, a test for liver function showing the existence of a coagulopathy due to liver failure.

■ History of growth failure – either yes or no. The answer is taken in consideration in the formula, adding 0.667 to the formula if growth failure (failure to thrive) present. This indicator factors in the weight and height development according to age.

The growth term is set to 0.667 when there is a suspicion of growth failure, proving that this weights a lot in the overall result. The listing age factor term will be set to 0.436 for patients listed before 1 year or under 2 year old.

PELD Score = 10 x (0.480 x ln(bilirubin) + 1.857 x ln(INR) - 0.687 x ln(albumin) + 0.436 + 0.667

The Pediatric End-stage Liver Disease is used by the UNOS (United Network for Organ Sharing) in the prioritization of liver transplants in children just as the MELD and MELD-Na scores are used for liver transplant procedures in adults.

In regard to PELD result interpretation, there is a correlation between the score and the prognosis and the higher the score is, the higher increase in mortality risk in patients awaiting liver transplant. Often higher scores also correlate with more critical conditions.

Allocating such a score and evaluating each individual case allows an efficient prioritization of patients on the waiting list and also maximizes the donation process success.

Cirrhosis stages

End stage liver disease is one of the other terms used for cirrhosis, because it succeeds the other stages of liver damage. The first one is inflammation (usually hepatitis), fatty deposits called steatosis and scaring of the liver (known as fibrosis). Cirrhosis is also graded from relatively mild to severe, grades A to C.

Cirrhosis develops in time and degrades the liver function and structure concomitantly and then leads to the need for liver transplant. Before that, cirrhosis is evaluated as either compensated or decompensated, in the fist case, the liver still fights the damage and continues its function while in the second state, the liver is no able to fulfill its function properly, leading to other complications and comorbidities such as portal hypertension, ascites or encephalopathy.

References

1) McDiarmid SV, Anand R, Lindblad AS; Principal Investigators and Institutions of the Studies of Pediatric Liver Transplantation (SPLIT) Research Group. (2002) Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation; 74(2):173-81.

2) Shneider BL, Neimark E, Frankenberg T, Arnott L, Suchy FJ, Emre S. (2005) Critical analysis of the pediatric end-stage liver disease scoring system: a single center experience. Liver Transpl; 11(7):788-95.

3) Neto JS, Carone E et al. (2010) Modified pediatric end-stage liver disease scoring system and pediatric liver transplantation in Brazil. Liver Transpl; 16(4):426-30.

4) Shinkai M, Ohhama Y, Take H, Fukuzato Y, Fujita S, Nishi T. (2003) Evaluation of the PELD risk score as a severity index of biliary atresia. J Pediatr Surg; 38(7):1001-4.