Development of a nomogram for predicting 2-year native liver survival in biliary atresia using dynamic liver function...

Area of Science:

• Pediatric Hepatology
• Surgical Gastroenterology
• Biostatistics

Background:

• Biliary atresia (BA) is a leading cause of pediatric liver disease requiring surgical intervention.
• The Kasai procedure is a common surgical treatment for BA, but outcomes vary significantly.
• Predicting long-term native liver survival (NLS) is crucial for guiding management and parental counseling.

Purpose of the Study:

• To develop and validate a predictive nomogram for 2-year NLS in children with BA post-Kasai surgery.
• To integrate dynamic liver function indexes into a robust prognostic model.
• To provide clinicians with a tool for individualized treatment decisions and early intervention strategies.

Main Methods:

• A cohort of 134 children with type III BA was analyzed.
• Logistic regression identified predictors of 2-year NLS, including age at surgery, jaundice clearance, fibrosis stage, and postoperative liver function tests (GGT, ALB, APRI).
• A nomogram was constructed and validated using internal bootstrap resampling and a training-test split, with performance assessed by AUC and calibration curves.

Main Results:

• Key predictors of NLS included advanced liver fibrosis (F4), high 3-month APRI, older age at surgery, elevated 3-month GGT, lower 3-month ALB, and failure of jaundice clearance.
• The nomogram demonstrated strong predictive performance with an AUC of 0.872 in the training set and 0.971 in the test set.
• The model showed consistent accuracy across different age subgroups.

Conclusions:

• A validated nomogram effectively predicts 2-year NLS in children with BA after Kasai surgery.
• The model integrates readily available clinical and biochemical data for prognostic assessment.
• This tool supports personalized management strategies and timely interventions for high-risk pediatric BA patients, especially in resource-limited settings.