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Web-based calculator for biliary atresia screening in neonates and infants with cholestasis
Dongying Zhao1, Shengli Gu2, Xiaohui Gong3
1Department of Neonatology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Insights
A new screening tool accurately identifies biliary atresia in infants with cholestasis. This model, integrated into a web calculator, aids physicians in clinical decision-making for early diagnosis and treatment.
Area of Science:
- Pediatric Gastroenterology
- Neonatal cholestasis diagnostics
- Biliary atresia screening
Background:
- Differentiating biliary atresia from other causes of cholestasis in infants is clinically challenging due to similar presentations.
- Early diagnosis of biliary atresia is crucial for effective treatment and improved outcomes.
Purpose of the Study:
- To develop and validate a predictive screening model for biliary atresia in cholestatic infants.
- To create a user-friendly, web-based calculator for clinical application.
Main Methods:
- A logistic regression model was constructed using data from 227 cholestatic infants.
- Variables were selected using the least absolute shrinkage and selection operator (LASSO) method.
- The model was externally validated in a separate cohort of 234 infants.
Main Results:
- The final model incorporated seven variables, achieving an AUC of 0.94 in the derivation cohort and 0.93 in the validation cohort.
- High sensitivity (91.46-93.1%) and specificity (80.15-86.62%) were observed.
- The model effectively stratified patients into risk groups, enabling exclusion of biliary atresia in the low-risk group.
Conclusions:
- The developed screening tool demonstrates high predictive value for biliary atresia.
- The web-based calculator can assist physicians in tertiary and community hospitals with diagnostic decision-making.
Background:
Distinguishing biliary atresia from non-biliary atresia in patients with cholestasis is challenging, as these conditions have a similar clinical presentation. We developed and externally validated a screening model for biliary atresia and devised a web-based calculator for use in clinical settings.
Methods:
A screening model was developed based on data from 227 cholestatic infants (82 and 145 with and without biliary atresia, respectively) and validated in 234 infants (90 and 144 with and without biliary atresia, respectively) admitted to three hospitals. Variables were selected from routine examination results using the least absolute shrinkage and selection operator method and entered into a logistic regression model to construct a biliary-atresia-risk-predicting equation. Cutoff values for risk stratification were estimated using model sensitivity, derived from the receiver-operating characteristic curves.
Results:
The final screening model included seven variables (i.e., weight at admission, clay-colored stools, γ-glutamyl transpeptidase and albumin levels at admission, abnormal gallbladder, triangular cord sign, and change in total bilirubin levels). The model generated an area under the curve of 0.94 with a sensitivity of 91.46 and specificity of 86.62 in the derivation cohort. This was confirmed in the validation cohort, as we found an area under the curve of 0.93 with a sensitivity of 93.1 and specificity of 80.15. Patients were stratified into three risk groups (low-, moderate-, and high-risk groups). Biliary atresia was excluded in the low-risk group. The high-risk group showed a higher detection rate of biliary atresia compared to the stool color screening method alone. This model was integrated into a user-friendly web-based system.
Conclusions:
The screening tool had a high predictive value and may help in decision-making by physicians at tertiary and community hospitals.
