From the Guidelines
The Pediatric End-Stage Liver Disease (PELD) score is a formula used to calculate the severity of liver disease in children under 12 years of age, utilizing total serum bilirubin, International Normalized Ratio of prothrombin time (INR), height, weight, and albumin 1.
Calculation of PELD Score
The PELD score is calculated based on the following formula:
- For patients less than 1 year old: PELD score = (0.480 x ln(bilirubin in mg/dL)) + (1.857 x ln(INR)) + (0.667 x (albumin in g/dL)) - (0.436 x age in years < 1)
- For patients 1 year or older: PELD score = (0.480 x ln(bilirubin in mg/dL)) + (1.857 x ln(INR)) + (0.667 x (albumin in g/dL)) Note that the score is then rounded to the nearest whole number, with a maximum score of 40 and a minimum score of -10 for patients with a high likelihood of spontaneous recovery 1.
Key Components
The key components of the PELD score include:
- Total serum bilirubin
- International Normalized Ratio of prothrombin time (INR)
- Height
- Weight
- Albumin These components are used to assess the severity of liver disease in children and prioritize them for liver transplantation 1.
Clinical Application
In clinical practice, the PELD score is used to prioritize children for liver transplantation, with higher scores indicating more severe liver disease and a higher priority for transplantation 1. However, it's worth noting that the PELD system has not resulted in standardization of listing practices in pediatric liver transplantation, and regional differences in PELD score utilization have been observed 1.
From the Research
Definition of PELD Score
- The Pediatric End-Stage Liver Disease (PELD) score is a numerical assessment of the risk of death in children with chronic liver disease awaiting liver transplantation 2, 3, 4.
- The PELD score is calculated using five objective factors: growth failure, age less than 1 year, international normalized ratio (INR), serum albumin, and total bilirubin 3, 4.
Purpose of PELD Score
- The primary purpose of the PELD score is to prioritize children awaiting liver transplantation based on their risk of mortality 3.
- The PELD score is used to allocate livers to children with the highest risk of death, thereby optimizing the use of limited organ resources 2, 3.
Calculation and Interpretation of PELD Score
- The PELD score is calculated using a formula that incorporates the five objective factors mentioned earlier 3, 4.
- A higher PELD score indicates a higher risk of mortality and prioritizes the child for liver transplantation 2, 3, 5, 6.
- Studies have shown that the PELD score is a reliable predictor of poor outcome in children with acute liver failure and chronic liver disease 5, 6.