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. 2018 Apr-Jun;23(2):81-86.
doi: 10.4103/jiaps.JIAPS_192_17.

Ratio of Preoperative and Postoperative Serum Bilirubin Levels Predicts Early Outcome Following Biliary Atresia Surgery

Kashish Khanna  1 , Veereshwar Bhatnagar  1 , Sandeep Agarwala  1 , Maddur Srinivas  1 , Siddhartha Datta Gupta  2
Affiliations

Ratio of Preoperative and Postoperative Serum Bilirubin Levels Predicts Early Outcome Following Biliary Atresia Surgery

Kashish Khanna et al. J Indian Assoc Pediatr Surg. 2018 Apr-Jun.

Abstract

Aim: This study investigates the fall in total serum bilirubin levels within 1 week after surgery, as a marker to predict early outcome in biliary atresia (BA) patients post-Kasai portoenterostomy (KP).

Methods: The ratio of total serum bilirubin levels at the 7th postoperative day to the preoperative level (TB7/TB0) in patients undergoing KP was calculated (January 2011-July 2015). Patients were stratified after 3-months follow-up into outcome groups depending on the clinical clearance of jaundice and TB7/TB0 ratio was correlated to outcome and liver histopathological changes in these groups.

Results: Sixty-one patients (M:F = 44:17), median age 75 days were included. At the end of 3 months, 27 (44.39%) were anicteric while 26 (42.6%) were still clinically jaundiced. Patients with a higher median value of TB7/TB0, that is, 0.856 were more likely to have jaundice at the end of 3 months as compared to patients with a lower median value of 0.615 (P < 0.0001). A cutoff TB7/TB0 ratio >0.723 predicted the KP outcome with 84.6% sensitivity and 81.5% specificity. The difference in TB7/TB0 ratio between patients with varying severity of liver histopathological changes was also significant, namely, cholestasis (P = 0.01), hepatocellular damage (P = 0.03), portal inflammation (P = 0.04), and portal fibrosis (P = 0.02).

Conclusions: The rapidity of fall in the total serum bilirubin levels within 1 week post-KP was able to predict the likely outcome in BA patients.

Keywords: Biliary atresia; Kasai portoenterostomy; serum bilirubin; surgical outcome.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristics curve showing the predictive ability of TB7/TB0 ratio using clinical outcomes, namely, (a) clinical jaundice, (b) color of the stools, and (c) total serum bilirubin. Sn: Sensitivity, Sp: Specificity, CC: Classified correctly, LR: Likelihood ratio, NPV: Negative predictive value, AUC: Area under the curve, CI: Confidence interval
See this image and copyright information in PMC

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