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25OH vitamin D3 in biliary atresia: a simple and under-utilised diagnostic method
Fangjuan Song1, Wanfu Li1, Zhida Chen1
1Department of Pediatric General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Insights
Low vitamin D levels (25(OH)D3) may help diagnose biliary atresia (BA) in infants. Combining 25(OH)D3 with ultrasound and GGT improves diagnostic accuracy for this serious liver condition.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Biochemistry
Background:
- Biliary atresia (BA) is a critical pediatric liver disease requiring early diagnosis and treatment (Kasai procedure within 60 days) to prevent liver failure.
- Current diagnostic methods like ultrasound and biochemical markers (e.g., GGT) have limitations, including false positives, necessitating improved early detection strategies.
- Severe vitamin D deficiency is frequently observed in BA patients, suggesting a potential link between vitamin D levels and BA diagnosis.
Purpose of the Study:
- To investigate the clinical utility and diagnostic significance of 25-hydroxyvitamin D3 (25(OH)D3) levels for the early diagnosis of biliary atresia (BA) in pediatric patients.
- To address the current diagnostic challenges in BA, where early confirmation before surgery remains inconclusive.
Main Methods:
- A comparative study involving pediatric patients diagnosed with BA (observation group) and those with other cholestatic liver diseases (control group).
- Data collection included ultrasound findings, serum gamma-glutamyl transpeptidase (GGT), direct bilirubin, and 25(OH)D3 levels for all participants.
- Statistical analysis was performed to compare these markers between the BA and non-BA groups.
Main Results:
- Significant differences were observed in ultrasound results, GGT, and 25(OH)D3 levels between BA and non-BA groups (P < 0.05).
- BA patients exhibited significantly higher GGT and direct bilirubin levels, and markedly lower 25(OH)D3 levels compared to the control group.
- Combining a 25(OH)D3 cut-off level (≤20.59) with ultrasound, or further including GGT (≥283.89), enhanced diagnostic sensitivity, specificity, and accuracy compared to 25(OH)D3 alone.
Conclusions:
- Serum 25(OH)D3 levels serve as a valuable indicator for the early diagnosis and differential diagnosis of BA in children.
- Combining 25(OH)D3 levels with ultrasound and GGT offers superior diagnostic efficiency for BA.
- These findings support the integration of 25(OH)D3 measurements into diagnostic protocols to facilitate timely surgical intervention for BA.
Background:
Biliary atresia is a form of pediatric cholangiopathy that affects the bile ducts of the liver. If left undiagnosed and untreated, it often leads to liver failure and death within 1-2 years of age. The treatment approach for this condition is recognized as the Kasai surgical procedure,which has been shown to achieve optimal outcomes when performed within 60 days of age. Furthermore, the timing of surgery has been identified as a crucial factor in determining patient prognosis. The current clinical practice involves the use of ultrasound as a primary diagnostic tool. Serum γ-glutamyltranspeptidase and other biochemical indicators are utilized in the diagnosis of biliary atresia, yet challenges persist regarding the occurrence of false-positive results. Consequently, there is an urgent clinical necessity to investigate non-invasive indicators for the early diagnosis of BA in children, with the objective of enhancing the accuracy of early diagnoses. In clinical practice, we frequently encounter cases of severe vitamin D deficiency in children diagnosed with BA. In recent years, the association between vitamin D and liver fibrosis in chronic liver disease has been substantiated. The objective of this study was to ascertain the clinical value and significance of 25(OH)D3 in the early diagnosis of BA.
Objective:
The best early diagnosis of BA is currently clinically inconclusive, and no test can confirm the diagnosis before surgery. To explore the clinical value of 25(OH)D3 in the diagnosis of biliary atresia (BA).
Methods:
The observation group comprised paediatric patients with biliary atresia admitted to the First Affiliated Hospital of Xinjiang Medical University between January 2024 and March 2025. The control group consisted of paediatric patients with cholestatic diseases caused by conditions other than biliary atresia during the same period.
Results:
There were significant differences in ultrasound results, serum γ-glutamyl transpeptidase level and 25(OH)D3 level between the BA group and the non-BA group (P < 0.05). The level of γ-glutamyl transpeptidase in the BA group was significantly higher than that in the non-BA group (P < 0.05), the level of direct bilirubin in the BA group was significantly higher than that in the non-BA group (P < 0.05), and the level of 25(OH)D3 in the BA group was significantly lower than that in the non-BA group (P < 0.05). A 25(OH)D3 cut-off level of 20.59 or lower combined with ultrasound results, or a 25(OH)D3 cut-off level of 20.59 or lower, ultrasound results, and serum γ-glutamyl transpeptidase cut-off levels of 283.89 or higher were combined to increase the sensitivity by 2.5%, specificity by 1.96%, PPV by 2.5%, NPV by 1.96%, and accuracy by 2.20% compared with 25(OH)D3 alone.
Conclusions:
The level of 25(OH)D3 can be used as a new force for diagnosing BA to provide an important detection basis for whether children need early surgical treatment, and is a good indicator for the diagnosis and differential diagnosis of BA.Moreover, the combined ultrasound results or 25(OH)D3 level, serum γ-glutamyl transpeptidase, and ultrasound results have higher diagnostic efficiency, and it is recommended to combine them for diagnosis.
