A Novel Model for Predicting the Clearance of Jaundice in Patients With Biliary Atresia After Kasai Procedure

Zhang, Yimao; Wang, Qi; Pu, Siyu; Wang, Jun-Xiang; Xiang, Bo; Liu, Juxian; Jin, Shuguang

doi:10.3389/fped.2022.837247

Cited by 6 publications

(4 citation statements)

References 36 publications

(51 reference statements)

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“…Children with normal GGT levels received liver transplantation at a younger age and had a significantly lower native liver survival rate. Zhang et al (31) analyzed the correlation between preoperative GGT and postoperative COJ in 175 patients and found that low GGT was an independent risk factor for failure of postoperative COJ. As a whole, these results suggest that lower preoperative GGT levels may be associated with poor prognosis after KP.…”

Section: Discussionmentioning

confidence: 99%

Low gamma-glutamyl transpeptidase levels at presentation are associated with severity of liver illness and poor outcome in biliary atresia

et al. 2022

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ObjectiveTo investigate the clinical features and prognosis of biliary atresia (BA) with normal or minimally elevated gamma-glutamyl transpeptidase (GGT).MethodsThe clinical data of patients with BA in our hospital between 2012 and 2017 were retrospectively studied. The patients were divided into a low-GGT group (GGT ≤ 300 IU/L) and a high-GGT group (GGT > 300 IU/L) according to the preoperative GGT level. The perioperative clinical parameters, the postoperative jaundice clearance within 6 months, and the 2-year native liver survival were compared among the groups.ResultsA total of 1,998 children were included in this study, namely, 496 in the low-GGT group and 1,502 in the high-GGT group. The ages and weights at the surgery in the low-GGT group were significantly lower than those in the high-GGT group (64.71 ± 21.35 vs. 68.64 ± 22.42 days, P = 0.001; 4.67 ± 1.03 vs. 4.89 ± 0.98 kg, P < 0.001). The levels of serum ALP, ALT, and AST in the low-GGT group were significantly higher than those in the high-GGT group before and 2 weeks after the surgery (ALP: 647.52 ± 244.10 vs. 594.14 ± 228.33 U/L, P < 0.001; ALT: 119.62 ± 97.14 vs. 96.01 ± 66.28 U/L, P < 0.001; AST: 218.00 ± 173.82 vs. 160.71 ± 96.32 U/L; P < 0.001). The INR of the low-GGT group was higher than that of the high-GGT group (1.05 ± 0.34 vs. 0.98 ± 0.20, P < 0.001), while FIB was lower than the high-GGT group (2.54 ± 0.67 vs. 2.73 ± 1.44 g/L; P = 0.006). The decreasing amplitude of TB and DB within 2 weeks after surgery in the low-GGT group was smaller than those in the high-GGT group (TB: 51.62 ± 71.22 vs. 61.67 ± 53.99 μmol/L, P = 0.003; DB: 33.22 ± 35.57 vs. 40.20 ± 35.93 μmol/L, P < 0.001). The jaundice clearance rate in the low-GGT group was significantly lower than that in the high-GGT group at 1, 3, and 6 months after surgery (17.70 vs. 26.05%; 35.17 vs. 48.58%; 38.62 vs. 54.64%, P < 0.001). In addition, the 2-year native liver survival rate in the low-GGT group was significantly lower than that of the high-GGT group (52.5 vs. 66.3%, P < 0.001 HR 1.80, 95% CI 1.38–2.33).ConclusionCompared to patients with high GGT, patients with normal or minimally elevated pre-operative GGT in BA were found to have poorer pre-operative liver function parameters, and post-operatively had lower jaundice clearance rates and worse 2-year native liver survival. This suggests a lower GGT at presentation in biliary atresia could be a sign of more severe liver injury.

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Section: Discussionmentioning

confidence: 99%

Low gamma-glutamyl transpeptidase levels at presentation are associated with severity of liver illness and poor outcome in biliary atresia

et al. 2022

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“…Previously, Zhang et al, evaluated a nomogram to predict the clearance of jaundice post-KPE ( 53 ). They demonstrated that the AUCs of their nomogram were 0.96 and 0.91, respectively, in the training and validation cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the serum TP level is an important indicator that can reflect physiological function of the liver and nutritional status of human body. The lower TP level implies more severe fibrosis and weaker physical conditions, which are likely to influence the outcome of KPE.Previously, Zhang et al, evaluated a nomogram to predict the clearance of jaundice post-KPE(53). They demonstrated that the AUCs of their nomogram were 0.96 and 0.91, respectively, in the training and validation cohorts.…”

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confidence: 99%

A nomogram model based on preoperative grey-scale US features and routine serum biomarkers to predict the outcome of infants with biliary atresia after Kasai portoenterostomy

Weng

Ye²,

Zhou³

et al. 2022

Front. Pediatr.

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ObjectiveTo establish a nomogram to predict the outcome of biliary atresia (BA) infants 3-months post- Kasai portoenterostomy (KPE).MethodsBA Infants who underwent KPE from two hospitals were included in the training (n = 161) and validation cohorts (n = 64). A logistic regression equation (Equation A) for predicting the serum total bilirubin (TBIL) level 3-month post-KPE was established in the training cohort. Then, a nomogram was developed based on Equation A in the training cohort and validated in the validation cohort. Moreover, a new equation (Equation B) was generated based on the nomogram and the size of the enlarged hilar lymph nodes (LNs) in the validation cohort. The predictive performance of the nomogram was evaluated by the receiver operating characteristic (ROC) curve and by calculating the area under the ROC curve (AUC), sensitivity, specificity, and positive (PPV) and negative (NPV) prediction values.ResultsA nomogram based on gallbladder morphology and serum levels of TBIL and total protein (TP) was established with AUC (95%CI) of 0.673 (0.595, 0.745) and 0.647 (0.518, 0.763), sensitivity (95%CI) of 71.4% (62.1%,79.6%) and 81.8% (59.7%,94.8%), specificity (95%CI) of 63.3% (48.3%,76.6%) and 47.6% (32.0%,63.6%), PPV (95%CI) of 81.6% (72.5%,88.9%) and 45.0% (29.3%,61.5%), and NPV (95%CI) 49.2% (36.4%,62.1%) and 83.3% (62.6%,95.3%), respectively, in the training and validation cohorts. Furthermore, in the validation cohort, the AUC (95%CI) of Equation B was 0.798 (95%CI: 0.679, 0.888), which was significantly higher than that of the nomogram (P = 0.042).ConclusionA nomogram based on the pre-KPE gallbladder morphology, TBIL, and TP to predict the outcome of BA 3-months post-KPE is established. Moreover, the addition of the size of the enlarged hilar LNs into the nomogram further improves its predictive value.

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“…Although KPE was developed more than half a century ago, a successful predictive model for precisely predicting response to KPE is lacking. Several potential clinical predictors (e.g., age, liver fibrosis, serum bilirubin levels) [10][11][12][13][14] and gene expressions 15,16 correlate with the prognosis of BA infants after KPE has been reported, but the predictive value of a single biomarker is limited. Previously, we built a clinical indicators-based nomogram that included age, 2DSWE, GGT, and APRI prior to KPE 17 to preoperatively predict the outcomes of KPE for BA patients.…”

Section: Introductionmentioning

confidence: 99%

Predictive model containing gene signature and shear wave elastography to predict patient outcomes after Kasai surgery in biliary atresia

Wang

Chen

Sun

et al. 2023

Hepatology Research

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AimsInfants with biliary atresia (BA) are treated with Kasai portoenterostomy (KPE) surgery, but many BA patients need subsequent salvage liver transplants. The aim of this study is to develop a comprehensive gene‐clinical model based on two‐dimensional shear wave elastography (2DSWE), liver gene expression, and other clinical parameters to predict response to KPE for BA patients.MethodsDifferentially expressed gene patterns between liver samples of BA (n = 102) and non‐BA control (n = 14) were identified using RNA sequencing analysis. Biliary atresia patients were then randomly assigned to training and validation cohorts. Gene classifier based on the differentially expressed genes was built in the training cohort. Nomogram models with and without gene classifier were further constructed and validated for predicting native liver survival of BA patients. The utility of the nomograms was compared by C‐index.ResultsUsing the least absolute shrinkage and selection operator model, we generated a nine‐gene prognostic classifier. The nomogram based on the nine‐gene classifier, age, preoperative 2DSWE, and albumin had the better C‐index compared to gene classifier alone in the training cohort (0.83 [0.76–0.90] vs. 0.69 [0.61–0.77], p = 0.003) and the validation cohort (0.74 [0.67–0.82] vs. 0.62 [0.55–0.70], p = 0.001). Using risk scores developed from the nomogram, the 12‐month survival rates of BA patients with native liver were 35.7% (95% confidence interval [CI], 22.7–56.3) in the high‐risk group and 80.8% (95% CI, 63.4–100.0) in the low‐risk group in the validation cohort.ConclusionsThe comprehensive genetic‐clinical nomogram based on preoperative 2DSWE, liver gene expression, and other clinical parameters can accurately predict response to KPE.

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A Novel Model for Predicting the Clearance of Jaundice in Patients With Biliary Atresia After Kasai Procedure

Cited by 6 publications

References 36 publications

Low gamma-glutamyl transpeptidase levels at presentation are associated with severity of liver illness and poor outcome in biliary atresia

Low gamma-glutamyl transpeptidase levels at presentation are associated with severity of liver illness and poor outcome in biliary atresia

A nomogram model based on preoperative grey-scale US features and routine serum biomarkers to predict the outcome of infants with biliary atresia after Kasai portoenterostomy

Predictive model containing gene signature and shear wave elastography to predict patient outcomes after Kasai surgery in biliary atresia

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