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Characteristics of infections and their risk factors in children with biliary atresia
Henry Shiau1, Jeremy M Schraw2, Krupa Mysore3
1Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, U.S.A..
Insights
Children with biliary atresia (BA) frequently develop infections like cholangitis and viral respiratory infections (VRI). Later Kasai hepatoportoenterostomy and lower platelet counts increase infection risk, indicating disease severity impacts susceptibility.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Infectious Diseases
Background:
- Biliary atresia (BA) is a serious condition in infants leading to liver damage.
- Children with BA are prone to various infections, impacting their health outcomes.
- Identifying infection patterns and risk factors is crucial for managing BA patients.
Purpose of the Study:
- To identify and characterize infections in children with biliary atresia.
- To determine risk factors associated with developing infections in this population.
- To explore patterns of infection development for better patient stratification.
Main Methods:
- Retrospective observational study of children with BA.
- Infections cataloged included VRI, bacteremia, cholangitis, and others.
- Kaplan-Meier analysis for infection-free survival and logistic regression for risk factors.
Main Results:
- 73.8% of children experienced at least one infection.
- Cholangitis and VRI were the most common infections.
- Kasai hepatoportoenterostomy after 45 days of life increased infection risk; lower platelet counts correlated with VRI risk.
Conclusions:
- Infection risk varies significantly among children with BA.
- Age at Kasai surgery and platelet count are key risk factors.
- Further research into immune deficiency in BA is needed to improve patient outcomes.
Background:
Children with biliary atresia (BA) may experience various infections (e.g., cholangitis, bacteremia, and viral respiratory infections (VRI)) throughout their disease course. This study aimed to identify and describe these infections and their risk factors for development in children with BA.
Methods:
This retrospective observational study identified infections in children with BA using predefined criteria, including VRI, bacteremia with and without central line (CL), bacterial peritonitis, positive stool pathogens, urinary tract infections, and cholangitis. Infections were identified until liver transplant, death or last follow-up with native liver. Infection-free survival was estimated by Kaplan-Meier analysis. Logistic regression was used to estimate odds of infection per clinical characteristics. Cluster analysis was performed to identify patterns of infection development.
Results:
48 of 65 (73.8%) children had ≥1 infection during their disease course (mean length of follow up: 40.2 months). Cholangitis (n = 30) and VRI (n = 21) were most common. Nearly half (45%) of all infections developed within 3-months of Kasai hepatoportoenterostomy. Kasai performed ≥45 days of life was associated with 3.5-fold increased risk of any infection (95% CI 1.2-11.4). Risk of VRI was inversely related to platelet count at 1-month post-Kasai (OR 0.5, 0.19-0.99). Cluster analysis of infectious patterns identified three unique cohorts of patients based on their infection history: no/few infections (n = 18), mostly cholangitis (n = 20) or mixed infections (n = 27).
Conclusion:
Variability of infection risk exists amongst children with BA. Age at Kasai and platelet count are risk factors for future infections, suggesting that patients with more severe disease are at greater risk. Cirrhosis associated immune deficiency may exist in chronic pediatric liver disease and should be the subject of future investigations in order to optimize outcomes.
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