Diagnostic Scoring in Biliary Atresia*

TL;DR

This study creates a scoring model to help diagnose biliary atresia in infants with jaundice, using stool color, ultrasound results, and blood test data.

Contribution

A novel diagnostic scoring model for biliary atresia using three clinical parameters with high sensitivity and specificity.

Findings

Acholic stools were present in 98% of biliary atresia patients.

The optimal GGT cut-off for BA diagnosis was ≥366 with 73% sensitivity and 77.8% specificity.

A scoring model with two parameters achieved 98% sensitivity and 83.3% specificity for BA diagnosis.

Abstract

The aim of this study was to develop a diagnostic scoring model to predict the need for intraoperative cholangiography in patients with neonatal cholestasis suspected of having biliary atresia (BA) and to aid in the early diagnosis of BA.

Data from 70 patients with neonatal cholestasis who underwent intraoperative cholangiography with a preliminary diagnosis of BA between 2019 and 2024 were retrospectively reviewed. Data from patients with and without BA were compared. Thescoring was based on 3 parameters: acholic stool observed clinically on inspection, findings suggestive of BA on ultrasound, and elevated gamma-glutamyl transferase (GGT) levels. The best GGT cut-off point for the diagnosis of BA was determined by receiver operating characteristic analysis. The diagnostic success of the scoring model for BA was statistically evaluated.

There were no significant differences in age and gender between BA and non-BA groups. Gamma-glutamyl transferase levels were elevated in all patients. Acholic stools were present in 98% of BA patients. Ultrasound findings suggestive of BA were present in 88.5% of patients with BA. The authors found the best GGT cut-off value for the diagnosis of BA to be ≥366 (73% sensitivity, 77.8% specificity). In the scoring model the authors developed, the presence of 2 parameters provided diagnostic success with high sensitivity (98%) and specificity (83.3%).

The study provides a reliable and sensitive diagnostic criterion to determine the need for intraoperative cholangiography in infants with neonatal cholestasis. These data should be validated in larger prospective case series.

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