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Determining Bile Duct Density in the Mouse Liver
Published on: April 30, 2019
Three-color risk stratification for improving the diagnostic accuracy for biliary atresia
Yan Chen1, Dongying Zhao1, Shengli Gu2
1Department of Neonatology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
Insights
This study developed a noninvasive algorithm to accurately differentiate biliary atresia in infants with cholestasis. The tool uses elastography and clinical factors for high-risk identification, improving early diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Diagnostic Algorithms
Background:
- Differentiating biliary atresia from other causes of infantile cholestasis is clinically challenging.
- Early diagnosis is crucial for effective treatment and improved outcomes in biliary atresia.
Purpose of the Study:
- To develop and validate a noninvasive algorithm for risk stratification to distinguish biliary atresia from infantile cholestasis.
- To improve the accuracy and efficiency of biliary atresia diagnosis in infants.
Main Methods:
- A prospective cohort of 187 infants with cholestasis was studied.
- Acoustic radiation force impulse elastography was used to measure shear wave speed.
- Stepwise regression identified predictors, leading to a sequential risk stratification algorithm (red, yellow, green).
Main Results:
- High-risk infants (shear wave speed > 1.35 m/s, triangular cord sign) showed 93.6% accuracy for biliary atresia.
- A three-color risk stratification tool achieved high diagnostic performance (AUC 0.983, sensitivity 98.7%, specificity 91.4%).
- The algorithm accurately identified 70.6% of patients as either high or low risk, aiding clinical decision-making.
Conclusions:
- A simple, noninvasive algorithm effectively identifies biliary atresia in infants with cholestasis.
- The developed risk stratification tool demonstrates high accuracy and potential for early diagnosis.
- This approach aids in distinguishing biliary atresia, facilitating timely intervention.
Objectives:
It is challenging to early differentiate biliary atresia from other causes of cholestasis. We aimed to develop an algorithm with risk stratification to distinguish biliary atresia from infantile cholestasis.
Methods:
In this study, we enrolled infants with cholestasis into 2 subgroups from January 2010 to April 2019. A prospective cohort (subgroup 2) of 187 patients (107 with biliary atresia and 80 without biliary atresia) underwent acoustic radiation force impulse elastography. Stepwise regression was used to identify significant predictors of biliary atresia. A sequential algorithm with risk stratification was constructed.
Results:
Among 187 patients, shear wave speed > 1.35 m/s and presence of the triangular cord sign were considered high risk for biliary atresia (red), in which 73 of 78 patients (accuracy of 93.6%) with biliary atresia were identified. Afterwards, γ-GT, abnormal gallbladder, and clay stool were introduced into the algorithm and 55 intermediate-risk infants were identified (yellow) with a diagnostic accuracy of 60% for biliary atresia. Of the remaining 54 infants who were classified as low-risk patients (green), the accuracy for excluding biliary atresia was 98.1%. By applying a three-color risk stratification tool, 70.6% patients were identified as either high risk or low risk for biliary atresia (area under the curve, 0.983; sensitivity, 98.7%; specificity, 91.4%). We also estimated the risk of biliary atresia in different color groups, which was 94.7% (95%CI, 94.3-95.5%) in the red group and 7.2% (95%CI, 6.6-8.3%) in the green group.
Conclusions:
Our simple noninvasive approach was able to identify biliary atresia with high accuracy.
Key Points:
• Five predictors, namely shear wave speed, triangle cord sign, γ-glutamyl transferase, abnormal gallbladder, and clay stool, were selected to identify biliary atresia in cholestasis. • Shear wave speed > 1.35 m/s and presence of the triangle cord sign were considered high-risk patients with a diagnostic accuracy of 93.6% for biliary atresia. • Risk for biliary atresia was high (red), intermediate (yellow), or low (green). In the red and green group, we achieved an extremely high diagnostic performance (area under the curve, 0.983; sensitivity, 98.7%; specificity, 91.4%).
