Belza et al reported a disease severity score for patients with short bowel syndrome. This can help to identify a patient who is likely to achieve enteral autonomy. The authors are from the University of Toronto and Hospital for Sick Children.
Patient selection: short bowel syndrome
Parameters:
(1) small bowel length in percent of normal
(2) ileocecal valve status
(3) serum conjugated bilirubin (direct bilirubin) in µmol/L
(4) percent of enteral nutrition tolerated at 6 months
Parameter
Finding
Points
small bowel length
<= 50%
0
> 50%
2
ileocecal valve
not intact
0
intact
1
serum direct bilirubin
< 34 µmol/L
2
>= 34 µmol/L
0
enteral tolerance
<= 50%
0
> 50%
3
where:
• A conjugated bilirubin >= 34 µmol/L for > 2 weeks without sepsis defined cholestasis.
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• A score >= 5 is associated with an 87% rate of enteral autonomy (weaning from parenteral nutrition).
Total Score
Severity
Probability of Weaning
0 to 2
severe
26%
3 to 5
moderate
53%
6 to 8
mild
97%
Performance:
• The area under the ROC curve is 0.83.
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