Serum bile acids early after portoenterostomy are predictive for native liver survival and portal hypertension in biliary atresia.

IF 2.4 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Linda Anderson, Maria Hukkinen, Iiris Nyholm, Mikko Niemi, Mikko P Pakarinen
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引用次数: 0

Abstract

Objectives: To compare the predictive value of serum bile acids on native liver survival (NLS) and portal hypertension (PH) at various time points early after portoenterostomy (PE) in biliary atresia (BA).

Methods: This was a retrospective observational study. Serum bilirubin and bile acid concentrations were defined by enzymatic spectrophotometry 1, 3, and 6 months after PE. After defining optimal bilirubin and bile acids cutoffs by area under the receiver operating characteristic (AUROC) curves, cutoffs were compared with other predictors of NLS and PH in Cox regression.

Results: Out of 56 patients, 42 (75%) achieved clearance of jaundice (COJ, bilirubin <20 µmol/L at 6 months). Both bilirubin and bile acids at 3 and 6 months were accurate predictors of NLS among all patients (AUROC 0.82-0.91, p < 0.001). In COJ patients, bile acids (AUROC 0.82, p = 0.003), but not bilirubin, at 1 month also predicted NLS. Among all patients, the strongest predictors of NLS were bilirubin >18.5 µmol/L and bile acids >150 µmol/L at 3 months, increasing the risk of transplantation/death seven- and eightfold, respectively (p < 0.001 for both). In COJ patients, the strongest predictor of NLS was bile acids >119 µmol/L at 3 months, increasing the risk of transplantation/death 12-fold (p = 0.014). Bile acids and bilirubin at 3 and 6 months predicted PH development in COJ patients with moderate accuracy (AUROC 0.72-0.78, p = 0.004-0.019). Bilirubin >8.5 µmol/L and bile acids >78 µmol/L at 6 months increased PH risk 13-fold (p < 0.001) and 4-fold (p = 0.006).

Conclusions: Serum bile acids offer a simple and useful additional tool to predict PE outcomes in BA, particularly after COJ.

门肠造口术后早期血清胆汁酸可预测先天性肝存活和胆道闭锁患者的门脉高压。
目的:比较胆道闭锁(BA)术后早期不同时间点血清胆汁酸对原生肝生存(NLS)和门脉高压(PH)的预测价值。方法:回顾性观察性研究。术后1、3、6个月采用酶促分光光度法测定血清胆红素和胆汁酸浓度。通过受试者工作特征(AUROC)曲线下的面积确定最佳胆红素和胆汁酸截断点后,在Cox回归中比较NLS和PH的其他预测因子的截断点。结果:56例患者中,42例(75%)在3个月时黄疸(COJ,胆红素18.5µmol/L,胆汁酸>150µmol/L)清除,移植/死亡风险分别增加7倍和8倍(p = 119µmol/L),移植/死亡风险增加12倍(p = 0.014)。胆汁酸和胆红素在3个月和6个月时预测COJ患者的PH发展具有中等准确性(AUROC为0.72-0.78,p = 0.004-0.019)。胆红素>8.5µmol/L和胆汁酸>78µmol/L 6个月后PH风险增加13倍(p)结论:血清胆汁酸提供了一个简单而有用的额外工具来预测BA的PE结局,特别是在COJ后。
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来源期刊
CiteScore
5.30
自引率
13.80%
发文量
467
审稿时长
3-6 weeks
期刊介绍: ​The Journal of Pediatric Gastroenterology and Nutrition (JPGN) provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition.
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