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The utility of shear wave elastography and serum biomarkers for diagnosing biliary atresia and predicting clinical outcomes

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Abstract

To investigate the utility of liver stiffness measurement by shear wave elastography (SWE) and several commonly used biomarkers in differentiating biliary atresia (BA) from other causes of cholestasis (non-BA) patients within 45 days and in predicting the postoperative prognosis. A consecutive series of medical records of patients presenting with cholestasis within 45 days in our institution between February 2016 and December 2020 was collected. The BA diagnosis was confirmed by intraoperative cholangiography (IOC). Other causes of cholestasis were confirmed by IOC, liver biopsy, genetic analysis, or recovery after conservative treatment. Preoperative and postoperative data were analyzed. A total of 156 patients were included, consisting of BA (n = 83) and non-BA (n = 73) cases. SWE and serum gamma-glutamyl transferase (GGT) showed better discriminative utility. The optimal cutoff values for SWE and GGT were > 7.10 kPa and > 195.4 U/L, with AUC of 0.82 (95% CI, 0.76–0.89; p < 0.0001) and 0.87 (95% CI, 0.82–0.93; p < 0.0001), respectively. Subgroup analysis showed the increased discriminative performance of SWE with age. Multivariable logistic regression analysis showed better diagnostic performance for SWE (adjusted OR, 35.03; 95% CI, 7.12–172.50) and GGT (adjusted OR, 24.70; 95% CI, 6.55–93.18) after adjusting for other confounders. The 30-day postoperative to preoperative serum direct bilirubin (DB) level, DB (post-30:pre), of > 0.3 showed the best predictive value for the need of liver transplantation, with HR of 6.15 (95% CI 1.95–19.38, P = 0.042).

Conclusion: Serum GGT level and liver stiffness measurement by SWE showed the best discriminative utility. The diagnostic performance of SWE increased with age. A DB (post-30:pre) value > 0.3 was associated with the need for liver transplantation in later life.

What is Known:

• Liver stiffness measurement by shear wave elastography (SWE) could help discriminate biliary atresia (BA) from other causes of cholestasis, with sensitivity of 70–90%.

• The postoperative total bilirubin less than 2 mg/dL within the first 3 months was a predictor of transplant-free survival.

What is New:

• The diagnostic performance of liver stiffness measurement by SWE increased with age.

• The 30-day postoperative direct bilirubin (DB) level to preoperative DB level, DB (post-30:pre), is a predictor for short-term clinical outcomes.

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Availability of data and material

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ALB:

Albumin

ALT:

Alanine aminotransferase.

AUC:

Area under the ROC curve

BA:

Biliary atresia

DB:

Direct bilirubin

DB (post-30:pre):

The ratio of 30-day postoperative serum DB level to preoperative DB level

GGT:

Gamma-glutamyl transferase

LT:

Liver transplantation

ROC:

Receiver operating characteristic

PGC:

Postprandial gallbladder contractility

SWE:

Shear wave elastography

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Acknowledgements

We thank Dr Yang Li of Shandong University Qilu Hospital for the review of the statistical analysis in this manuscript preparation.

Funding

This study was supported by grants from Natural Science Foundation of Tianjin (No. 19JCYBJC26600); China Postdoctoral Science Foundation (No. 2019M660921 and 2020T130436).

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Author notes

  1. Yakun Liu and Chunhui Peng contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, No. 56 Nanlishi St, Beijing, 100045, China

    Yakun Liu, Chunhui Peng, Kai Wang, Dongyang Wu, Jun Yan & Yajun Chen

  2. Institute of Radiation Medicine, Chinese Academy of Medical Science & Peking Union Medical College, No. 238 Baidi St, Tianjin, 300192, China

    Wenjun Tu

  3. Key Lab of Cerebral Microcirculation in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng St, Taian, 271000, Shandong, China

    Wenjun Tu

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Contributions

Prof. Yajun Chen had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Yakun Liu: Study design, interpretation of data, drafting of the manuscript. Revision of the manuscript. Chunhui Peng: acquisition of data, critical revision of the manuscript. Kai Wang: statistical analysis. Dongyang Wu: statistical analysis. Jun Yan: statistical analysis and revision of the manuscript. Wenjun Tu: obtained funding, interpretation of data, revision of the manuscript. Yajun Chen: study design and supervision. Final approval of the version to be published.

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Correspondence to Wenjun Tu or Yajun Chen.

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This study was approved by the Ethical Committees of Beijing Children’s Hospital, with a waiver of informed consent given its retrospective nature (number: [2021]-E-018-R).

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Informed consent was waived for its retrospective nature.

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The authors declare no competing interests.

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Liu, Y., Peng, C., Wang, K. et al. The utility of shear wave elastography and serum biomarkers for diagnosing biliary atresia and predicting clinical outcomes. Eur J Pediatr 181, 73–82 (2022). https://doi.org/10.1007/s00431-021-04176-y

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  • DOI: https://doi.org/10.1007/s00431-021-04176-y

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