Comparison of different diagnostic methods in infants with Cholestasis

Dehghani, Seyed Mohsen; Haghighat, Mahmood; Imanieh, Mohammad Hadi; Geramizadeh, Bita

doi:10.3748/wjg.v12.i36.5893

Cited by 56 publications

(61 citation statements)

References 13 publications

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“…However, the gold standard of diagnosis is exploratory laparotomy. 2,11,21 Despite their help in differentiating intrahepatic from No statistically significant differences were found in serum levels of AST, ALT and AP, similar to results obtained in the present study.…”

Section: Discussionsupporting

confidence: 90%

Diagnóstico diferencial de colestase neonatal: parâmetros clínicos e laboratoriais

Bellomo-Brandão¹,

Arnaut²,

Tommaso³

et al. 2010

J. Pediatr. (Rio J.)

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Objective: To evaluate if clinical and laboratory parameters could assist in the differential diagnosis of intra and extra-hepatic neonatal cholestasis (NC). Methods:Retrospective study of NC patients admitted at the Pediatric Hepatology Outpatient Clinic of the teaching hospital of Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil, between December 1980 and March 2005. The approach to the diagnosis of NC was standardized. According to diagnosis, patients were classified into two groups: I (intra-hepatic neonatal cholestasis) and II (extra-hepatic neonatal cholestasis). In order to verify if there was association with the categorical variable, the chi-square and Mann-Whitney tests were used, with corrections for age for the covariance analysis (ANCOVA). The determination of accuracy of the clinical and laboratory variables for differentiation of the groups was made using the analysis of the ROC curve. Results:One hundred and sixty-eight patients were evaluated (group I = 54.8% and group II = 45.2%). In the patients with less than 60 days of life there was predominance of intra-hepatic causes, whereas, in those older than 60 days, there was predominance of extra-hepatic etiology (p < 0.001). Median birth weight was lower in group I (p = 0.003), as well as length at birth (p = 0.007). Median values of direct bilirubin were higher in group II (p = 0.006). Values of gamma-glutamyltransferase (GGT) (10 times higher than the limit of normality) presented sensitivity of 56.3%, specificity of 91.5%, and accuracy of 75.7% for the diagnosis of extra-hepatic cholestasis. Conclusion:In the present study, extra-hepatic NC presented greater weight and length at birth, fecal hypocholia/ acholia, choluria, hepatomegaly, increase in GGT (10.8 times higher than the limit of normality), and a delay for investigation in the tertiary center.J Pediatr (Rio J). 2010;86(1):40-44: Neonatal cholestasis, children, hepatitis.

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Section: Discussionsupporting

confidence: 90%

Diagnóstico diferencial de colestase neonatal: parâmetros clínicos e laboratoriais

Bellomo-Brandão¹,

Arnaut²,

Tommaso³

et al. 2010

J. Pediatr. (Rio J.)

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“…1 Liver biochemical tests show nonspecific and variable elevation in neonatal cholestasis; but both our study, and studies reported by Mieli-Vergani et al, and Dehghani et al revealed that relatively lower AST and higher GGT levels were seen in infants with BA. 8,13 We also detected in infants with BA, serum protein levels were high from infants with NH, which might be explained by infants with NH had more metabolic or infectious diseases that caused malnutrition. In patients with NH, 35% of the patients weight, and 25% of the patients height were below 3 rd percentile.…”

Section: Resultsmentioning

confidence: 70%

Evaluation of Infants with Neonatal Cholestasis: Experience of a Tertiary Referral Center in Turkey

Gökçebay¹,

Gülerman²,

Arda³

et al. 2015

Turkiye Klinikleri J Med Sci

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ABS TRACT Objective: Neonatal cholestasis can be the initial evidence of a heterogeneous group of diseases of different etiologies. The aim of the study is to evaluate the patients with neonatal cholestasis and analyse the etiologic factors, diagnostic tools and outcome. Material and Methods: Seventy-five patients (65% males, 45% females) between 0-6 months of age with neonatal cholestasis were retrospectively evaluated; analysed for the clinical, laboratory, radiological, scintigraphic data and histopathological findings from liver biopsies. Results: Eighty per cent of the infants' admitted to our hospital because of prolonged jaundice. The onset of the jaundice was in the first week of life in 64% of the cases, but admission time of the referral center was median two months. Biliary atresia (BA) was determined in 21 (28%), neonatal hepatitis (NH) in 54 (72%) of the patients. Biliary atresia group had significantly more frequent acholic stool, relatively lower aspartate aminotransferase, but higher gamma-glutamyl transpeptidase, and serum protein levels. Liver biopsy and hepatobiliary scintigraphy were the most sensitive methods for differentiation BA from NH (p<0.05). During the follow-up period, 13 of the patients (18%) died, whereas cholestasis improved in 14 of the patients with NH (27%) within median 6 months. Survival rate at one year was 45.5% for the patients with BA, and 87% for the patients with NH. So patients with NH had better prognosis (p<0.05). Conclusion: It has been evident that early diagnosis and intervention of treatable causes of neonatal cholestasis have a vital importance.Key Words: Jaundice, neonatal; cholestasis; biliary atresia ÖZET Amaç: Neonatal kolestaz farklı nedenlerle oluşan heterojen bir grup hastalığın ilk bulgusu olabilir. Bu çalışmanın amacı neonatal kolestazlı hastaların değerlendirilmesi ve etyolojik faktör-ler, tanı yöntemleri ve sonuçlarının incelenmesidir. Gereç ve Yöntemler: Neonatal kolestazı olan, yaşları 0-6 ay arasında değişen 75 hasta (%65'i erkek, %45'i kız) geriye dönük olarak değerlen-dirildi; klinik, laboratuvar, radyolojik, sintigrafik verileri ve karaciğer biyopsilerindeki histopatolojik bulguları incelendi. Bulgular: Bebeklerin %80'i uzamış sarılık nedeniyle hastanemize başvurmuştu. Olguların %64'ünde sarılık yaşamın ilk haftasında başlamasına rağmen ortanca başvuru zamanı iki aydı. Hastaların 21'inde (%28) bilier atrezi (BA), 54'ünde (%72) neonatal hepatit (NH) saptandı. Bilier atrezi grubunda akolik dışkı daha sık, aspartat aminotransferaz görece düşük, ancak gama-glutamil transpeptidaz ve serum protein düzeyleri yüksek saptandı. Karaciğer biyopsisi ve hepatobilier sintigrafi BA'nın NH'den ayrımında en duyarlı yöntem-lerdi (p<0,05). İzlem sırasında 13 hasta (%18) kaybedildi, ancak NH'li 14 hastada (%27) kolestaz ortanca 6 ay içinde düzeldi. Bilier atrezili hastaların bir yıllık yaşam oranı %45,5 iken, NH tanılı hastaların %87 idi. Neonatal hepatitli hastaların prognozları daha iyiydi (p<0,05). Sonuç: Erken tanı ile neonatal kolestazın tedavi edilebilir ned...

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“…In our study, the presence of acholic stool and early onset jaundice were key features suggestive of BA, while parental consanguinity and splenomegaly were suggestive of non-BA cholestasis. In the literature, acholic stool was present in 83%-94.7% of patients with BA compared with 45.7%-56.5% of patients with non-BA cholestasis (12)(13)(14). The specificity and sensitivity of acholic stool in cases of BA have also been reported at 74%-86% and 83%-100%, respectively (11,15,16 The mean time to presentation at our clinic was 2 months, most being spent outside hospital, which contrasts with reported presentations between 62 and 112 days in the literature (11)(12)(13)17).…”

Section: Discussionmentioning

confidence: 99%