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Algorithm of Kaufman et al for Predicting Parenteral Nutrition-Associated Liver Disease (PNALD) in a Pediatric Patient with Short Bowel Syndrome of Infancy

Purpose: To determine the risk of liver failure in an infant receiving parenteral nutrition for the short bowel syndrome of infancy.

Description

Kaufman et al identified laboratory findings predicting of impending liver failure associated with parenteral nutrition given for the short bowel syndrome of infancy. The authors are Georgetown University Hospital and Children's National Medical Center, MedStar Research Institute and Favaloro Foundation University Hospital (Buenos Aires).


Patient selection: infant with short bowel syndrome of infancy maintained on parenteral nutrition

 

A simple rule is to refer the patient for transplant if the the total bilirubin is >= 6 mg/dL at 3 to 6 months of age. This correlated with a risk of liver failure >= 36%.

 

The authors developed a model for predicting the risk of liver failure based on laboratory tests performed from 3 to 6 months of age.

 

Parameters:

(1) serum total bilirubin in mg/dL

(2) platelet count per µL

(3) serum albumin in g/dL

 

X =

= (0.1783 * (total serum bilirubin)) - (0.0085 * (platelet count) / 1000) - (1.3929 * (serum albumin)) + 5.1431

 

probability of liver failure =

= 1 / (1 + EXP((-1) * X))


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Specialty

Objective

ICD-10