Combination of gamma-glutamyl transferase and liver stiffness measurement for biliary atresia screening at different ages: a retrospective analysis of 282 infants

Shen, Qiulong; Tan, Sarah Siyin; Wang, Zengmeng; Cai, Siyu; Pang, Wenbo; Peng, Chunhui; Chen, Yajun

doi:10.1186/s12887-020-02172-z

Cited by 13 publications

(26 citation statements)

References 20 publications

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“…Additionally, the LSM value mainly reflects the degree of liver fibrosis, which is one of the main pathological features of BA (28). Previous studies have applied the LSM assessment for the diagnostic and prognostic prediction of BA (29)(30)(31). Wu et al found that an LSM value > 7.7 kPa was a predictive factor for discriminating BA patients from other cholestatic patients, and patients with an LSM value > 16 kPa often require early liver transplantation (29).…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2022

Front. Pediatr.

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BackgroundThe failed clearance of jaundice (CJ) in patients with biliary atresia (BA) after the Kasai procedure (KP) often leads to a shorter native liver survival (NLS) time and earlier liver transplantation. We aimed to investigate risk factors of failed CJ and establish a novel nomogram model to predict the status of CJ.MethodsWe retrospectively reviewed institutional medical records from January 2015 to April 2020 and enrolled BA patients post-KP, randomly divided into training and testing cohorts at a ratio of 7:3, and further subdivided into cleared and uncleared jaundice groups. Univariate and multiple logistic regression analyses were used to select risk factors to establish the nomogram in the training cohort. The performance of the nomogram was evaluated by calculating the areas under the receiver operating curve (AUC) in both cohorts.ResultsThis study included 175 BA patients post-KP. After univariate and multiple logistic regression analyses, Cytomegalovirus IgM +ve associated BA (OR = 3.38; 95% CI 1.01–11.32; P = 0.04), ln γ-glutamyl transpeptidase (GGT) (OR = 0.41; 95% CI 0.22–0.80; P = 0.009), thickness of the fibrous portal plate (OR = 0.45; 95% CI 0.27–0.76; P = 0.003), liver stiffness measurement (LSM) (OR = 1.19; 95% CI 1.06–1.34; P = 0.002), and multiple episodes of cholangitis (OR = 1.65; 95% CI 1.13–2.41; P = 0.01) were identified as independent risk factors of unsuccessful CJ to construct the nomogram. The receiver operating characteristic curve (ROC) analysis suggested good nomogram performance in both the training (AUC = 0.96) and testing cohorts (AUC = 0.91).ConclusionOur nomogram model including several risk factors effectively predicts CJ in patients post-KP, which could aid in clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2022

Front. Pediatr.

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“…Shen et al explored the diagnostic accuracy for BA of parallel testing of GGT and LSM by the SuperSonic system among patients with cholestasis separated into three age groups (≤60 days, n = 124; 61-90 days, n = 124; and 91-120 days, n = 34) in a retrospective study. (27) Infants younger than 30 days of age (9 patients) were not grouped separately because of the small number. The optimal cutoff LSM value in the group aged 60 days or younger was 7.5 kPa (AUC of 0.761, sensitivity of 87.8%, specificity of 58.0%).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Transient Elastography in Biliary Atresia Among Infants With Cholestasis

Boo

Chang

Jeng

et al. 2021

Hepatology Communications

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Biliary atresia (BA) is a challenging liver disease in infancy. Early diagnosis of BA is important for timely hepatoportoenterostomy. We evaluated the age-specific diagnostic performance of transient elastography (TE) with a liver stiffness measurement (LSM) greater than 7.7 kPa in BA among infants with cholestasis. A total of 61 infants with cholestasis (5-121 days of age) were enrolled in this prospective follow-up study; 15 infants were BA. Four age groups were defined (≤30, 31-60, 61-90, and 91-180 days). Picrosirius red staining was performed to quantify the percentage of collagen fibers in liver specimens. The utility of an LSM greater than 7.7 kPa for diagnosis of BA among infants with cholestasis was compared among age groups. In all four groups, TE showed high diagnostic power for BA using the criterion of an LSM greater than 7.7 kPa. Positive predictive values were 100%, 100%, and 100% in the groups aged 30 days or younger, 31 to 60 days, and 61 to 90 days, respectively. Respective negative predictive values were 90.9%, 94.7%, and 100%, and respective diagnostic accuracies were 92.9%, 95.2%, and 100%. The positive predictive value, negative predictive value, and diagnostic accuracy were 100%, 100%, and 100%, respectively, for LSM greater than 8.8 kPa in the group aged 91 to 180 days. The LSM was positively correlated with the percentage of collagen fibers stained by picrosirius red (P = 0.03). Conclusion: In this prospective follow-up study, TE had good diagnostic accuracy for differentiation of BA from non-BA cholestasis in infants with cholestasis who were 90 days of age or younger. The LSM was significantly positive correlated with the liver fibrosis status stained by picrosirius red in infants with cholestasis. (Hepatology Communications 2021;0:1-9).

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“…This study was approved by the Ethics Committee of the Children's Hospital of Fudan University. We reviewed several studies on the diagnostic efficacy of GGT in differentiating BA from other cholestatic diseases and found that the threshold values in most studies were between 250 and 300 IU/L (1,4,6,(13)(14)(15). Therefore, 300 IU/L was used as the critical cut-off value differentiating the low-GGT group (≤300 IU/L) from the high-GGT group (>300 IU/L) based on the preoperative GGT level.…”

Section: Methodsmentioning

confidence: 99%

“…The serum level of gamma-glutamyl transpeptidase (GGT) in most patients with biliary atresia (BA) is significantly increased, which plays an important role in the differential diagnosis of neonatal cholestatic disorders (1)(2)(3)(4)(5)(6)(7). However, some neonates initially presenting with normal or minimally elevated GGT levels are eventually, and sometimes unexpectedly, confirmed to have BA (8,9).…”

Section: Introductionmentioning

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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Combination of gamma-glutamyl transferase and liver stiffness measurement for biliary atresia screening at different ages: a retrospective analysis of 282 infants

Cited by 13 publications

References 20 publications

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

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

Diagnostic Performance of Transient Elastography in Biliary Atresia Among Infants With Cholestasis

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

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