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Diagnostic value of procalcitonin and apo-e in extrahepatic biliary atresia
Mandana Rafeey1, Lida Saboktakin1, Jamshid Shoa Hassani1
1Department of Pediatrics, Pediatric Health Research Center.
Insights
Procalcitonin (PCT) and apolipoprotein E (Apo-E) show moderate accuracy for diagnosing extrahepatic biliary atresia (EHBA) in infants. Combining these markers with other tests may improve EHBA diagnosis.
Area of Science:
- Neonatal cholestasis research
- Biomarker diagnostics in pediatrics
Background:
- Extrahepatic biliary atresia (EHBA) is a primary cause of neonatal cholestasis.
- Early EHBA diagnosis is crucial for timely surgical intervention and improved infant survival rates.
Purpose of the Study:
- To evaluate the diagnostic accuracy of procalcitonin (PCT) and apolipoprotein E (Apo-E) levels in differentiating EHBA from other causes of neonatal cholestasis.
- To assess the sensitivity, specificity, and predictive values of PCT and Apo-E for EHBA detection.
Main Methods:
- Prospective study involving 18 infants with EHBA and 15 with other cholestatic conditions.
- Measurement of serum PCT and Apo-E levels.
- Receiver Operating Characteristic (ROC) curve analysis to determine diagnostic performance metrics.
Main Results:
- Apo-E showed significant positive correlations with SGOT, SGPT, and GGT.
- PCT demonstrated an inverse correlation with GGT.
- Area under the curve (AUC) for PCT was 0.69 and for Apo-E was 0.68, indicating moderate diagnostic accuracy.
Conclusions:
- Both PCT and Apo-E exhibit relatively good accuracy but are insufficient as standalone diagnostic markers for EHBA.
- Combining PCT and Apo-E with other biomarkers and imaging modalities is recommended to enhance diagnostic accuracy for EHBA.
Objective:
Extrahepatic biliary atresia (EHBA) is one of the main causes of neonatal cholestasis. Its early diagnosis could increase the survival of the infants with early surgery. We evaluated the diagnostic accuracy of procalcitonin and apolipoprotein E (Apo-E) levels in infants with and without EHBA.
Methods:
This prospective study included 18 infants with EHBA and 15 infants with other causes of cholestasis. Blood samples were taken from each patient and different markers including procalcitonin and Apo-E levels were measured. ROC analysis was used to define sensitivity, specificity, positive and negative predictive value (PPV and NPV) for procalcitonin and Apo-E. Findings : There was a significantly positive correlation between Apo-E and SGOT (r=0.37, P=0.03), SGPT (r=0.38, P=0.02) and GGT (r=0.38, P=0.02), and an inverse correlation between procalcitonin and GGT (r=-0.45, P=0.01). Area under curve (AUC) for procalcitonin was 0.69 (P=0.05) with cut-point of 0.735 ng/ml. The sensitivity, specificity, PPV and NPV was 67%, 61%, 69% and 59%, respectively. AUC for Apo-E was 0.68 (P=0.06) for cut-point of 61.25 ng/ml with sensitivity, specificity, PPV and NPV of 67%, 67%, 71% and 67%, respectively.
Conclusion:
Both PCT and Apo-E have relatively good accuracy in diagnosing EHBA cases; we could not rely on these markers for diagnosis of EHBA, however, combinations of these biomarkers with other markers and imaging tests could improve their accuracy and may help to achieve a rapid and accurate diagnosis of EHBA.
