Direct Bilirubin and Risk of Biliary Atresia

Early detection of biliary atresia (BA) is important for optimal treatment. Direct bilirubin (D-bil) levels are used for BA screening. In this study, we aimed to determine the sensitivity and specificity of elevated D-bil and the direct-to-total bilirubin (D/T) ratio for BA detection in high-risk in...

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Published in:Pediatrics (Evanston) 2022-06, Vol.149 (6), p.1
Main Authors: Liao, Fang-Min, Chang, Kai-Chi, Wu, Jia-Feng, Chen, Huey-Ling, Ni, Yen-Hsuan, Chang, Mei-Hwei
Format: Article
Language:English
Subjects:
Biliary atresia
Biliary Atresia - diagnosis
Bilirubin
Cross-Sectional Studies
Humans
Infant
Infant, Newborn
Infants
Liver Function Tests
Neonates
Newborn babies
Pediatrics
Retrospective Studies
Risk groups
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Summary:Early detection of biliary atresia (BA) is important for optimal treatment. Direct bilirubin (D-bil) levels are used for BA screening. In this study, we aimed to determine the sensitivity and specificity of elevated D-bil and the direct-to-total bilirubin (D/T) ratio for BA detection in high-risk infants. This retrospective, cross-sectional study was conducted in a tertiary medical center in Taiwan. Infants indicated for total bilirubin and D-bil measurements before age 60 days were included. The first bilirubin assessment was considered the test point. BA diagnosis was based on International Classification of Diseases, Ninth and Tenth Revision, codes 751.61 and Q44.0 to Q44.3, respectively. Between January 2009 and December 2016, 4468 infants were enrolled, including 38 with BA. Among infants aged 3 to 60 days, a sensitivity of 100% (95% confidence interval, 90.3-100.0) was found for D-bil ≥1.0 mg/dL and either D-bil ≥1.0 mg/dL or D/T ratio ≥20%. However, D-bil ≥1.0 mg/dL had higher specificity (77.3% [76.0-78.5] vs 68.3% [66.8-69.7], respectively). In newborns aged 0.45 mg/dL was a better cutoff point in receiver operating characteristic analysis, with a sensitivity and specificity of 100% (95% CI: 15.8-100) and 15.4% (95% CI, 11.8-19.7), respectively. D-bil ≥1.0 mg/dL was better for BA detection than the D/T ratio in infants aged 3 to 60 days. For newborns aged
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2021-053073