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Paediatric Hepatology Dependency (PHD) Score of Cowley et al

Purpose: To evaluate a pediatric patient with liver disease using the Paediatric Hepatology Dependency (PHD) score of Cowley et al.

Description

Cowley et al developed the Paediatric Hepatology Dependency (PHD) score for evaluating children with liver disease. This can be monitored over time to evaluate the patient's clinical course and need for medical care. The authors are from Birmingham Children's Hospital in England.


Parameters:

(1) serum albumin in g/L

(2) AST in IU/L

(3) total bilirubin in µmol/L

(4) INR

(5) ascites

(6) nutritional support

(7) organ dysfunction (respiratory, cardiovascular, renal, CNS)

(8) blood product support during previous week

(9) sepsis

(10) intravenous access and fluid balance

 

Parameter

Finding

Points

serum albumin

> 35 g/L

0

 

30 to 34 g/L

1

 

25 to 29 g/L

2

 

20 to 24 g/L

3

 

< 20 g/L

4

AST in IU/L

0 to 50 IU/L

0

 

51 to 150 IU/L

1

 

151 to 300 IU/L

2

 

301 to 500 IU/L

3

 

> 500 IU/L

4

total bilirubin

0 to 20 µmol/L

0

 

21 to 70 µmol/L

1

 

71 to 150 µmol/L

2

 

151 to 300 µmol/L

3

 

> 300 µmol/L

4

INR

1

0

 

1.1 to 1.4

1

 

1.5 to 1.9

2

 

2.0 to 2.3

3

 

>= 2.4

4

ascites

none

0

 

none while on treatment

1

 

mild

2

 

gross

3

 

gross requiring drainage

4

nutritional support

none

0

 

enteral feeding (NG tube)

1

 

modular feed

2

 

IV fluids

3

 

TPN

4

number of organ failures

0

0

 

1

1

 

2

2

 

3

3

 

4

4

blood product support

0 products transfused

0

 

1 product transfused

1

 

2 products transfused

2

 

3 products transfused

3

 

4 or more products transfused

4

sepsis

none

0

 

febrile

1

 

IV antibiotics administered

2

 

infection confirmed (positive microbiology test)

3

 

DIC, septic shock, acidosis

4

intravenous access

none

0

 

peripheral vein

1

 

IV glucose required

2

 

central access

3

 

invasive monitoring

4

 

where:

• Blood products include packed RBCs, platelets, fresh frozen plasma, cryoprecipitate and/or albumin.

• CNS failure is any degree of encephalopathy.

• Cardiac failure is the need for any inotropic support.

• Respiratory failure is the need for continuous oxygen supplementation.

• Renal failure is an increase in the serum creatinine >= 1.5 times upper limit of normal for age OR a urine output < 0.5 mL per kg per hour for 24 hours (< 12 mL per kg per day).

 

total score =

= SUM(points for all 10 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 40

• The higher the score the more severe the illness.

• A score >= 20 indicates significant illness.

• A score > 15 had an odds ratio of 7 for transplant or death within 6 months.


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Specialty

Objective

ICD-10