Abstract
Purpose
Various prognostic predictors for biliary atresia (BA) have been identified. This study aimed to evaluate the serial changes in the preoperative and postoperative ubiquitous inflammatory biomarkers and their relationship with the outcomes in patients with BA.
Patients and methods
Forty-three BA patients were retrospectively reviewed to investigate serial levels of ubiquitous inflammatory biomarkers, including C-reactive protein (CRP) and lymphocyte ratio, and outcomes. The patients with BA were divided based on their outcomes into two prognostic groups: the native liver survivor group (n = 30) and the survivors with living-donor liver transplant group (n = 13).
Results
The area under the receiver operating characteristic (ROC) curve analysis showed that a preoperative lymphocyte ratio of < 61% and CRP value > 0.1 mg/dl predicted a poor outcome. In the ROC curve analysis, the timing of reaching the cut-off value of CRP after Kasai portoenterostomy was postoperative day (POD) 57. The third postoperative week, which was the timing of the discontinuation of steroid therapy, was the branchpoint of inflammatory markers between the two prognostic groups.
Conclusion
The POD 57 CRP level predicts the surgical outcome of Kasai portoenterostomy. The postoperative anti-inflammatory management of BA can be monitored by the ubiquitous inflammatory biomarkers CRP and the preoperative lymphocyte ratio.
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Acknowledgements
We thank Mr. Brian Quinn for his comments and help with the manuscript. This study was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS: 20K21581, 20K17588, 20K08933, 17K11514), a research grant from The Mother and Child Health Foundation, and a research grant from the Kawano Masanori Memorial Public Interest Incorporated Foundation for Promotion of Pediatrics.
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T.H., T.M. and S.I. wrote the main manuscript text. T.H., S.K., M.M., K.T. and S.I. did the data analysis and data interpretation. M.M., K.Y. and S.O. prepared figures 1-5. K.Y., W.Y.and M.M. prepared Table1. S.I. made critical revision. All authors reviewed the manuscript.
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Harumatsu, T., Muraji, T., Sugita, K. et al. The preoperative lymphocyte ratio and postoperative C-reactive protein are related to the surgical outcome in biliary atresia: an analysis of serial ubiquitous markers of inflammation. Pediatr Surg Int 38, 1777–1783 (2022). https://doi.org/10.1007/s00383-022-05231-x
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DOI: https://doi.org/10.1007/s00383-022-05231-x