Gamma‐Glutamyl Transferase Combined With Conventional Ultrasound Features in Diagnosing Biliary Atresia

Abstract

Objectives To develop and validate a biliary atresia (BA) diagnostic score based on serum gamma‐glutamyl transferase (GGT) levels and conventional ultrasound features for discriminating BA in patients with jaundice from two centers. Methods A total of 958 patients from one hospital were classified as the derivation cohort, and 725 patients from another hospital were classified as the validation cohort. The optimal GGT cutoff value for diagnosing BA was calculated in the derivation cohort and subsequently verified in the validation cohort. Gallbladder abnormalities and the triangular cord (TC) sign were evaluated in all patients. A BA diagnostic score was developed for diagnosing BA using the GGT levels, gallbladder abnormalities and the TC sign based on the data from the derivation cohort followed by external validation. Results Based on the optimal cutoff value 350.0 U/L, GGT yielded a sensitivity of 59.3% and specificity of 85.4% in diagnosing BA. The area under the receiver operating characteristic curve (AUC 0.724) was inferior to that of the gallbladder (AUC 0.911, P < .001) and comparable to that of the TC sign (AUC 0.771, P = .128). The combination of GGT and ultrasound diagnosis could help to reduce the misdiagnosis of 9 infants with BA. The BA diagnostic score yielded a sensitivity of 93.3% and specificity of 95.0% with the highest AUC in this study (0.941). Conclusions GGT can add diagnostic value to ultrasound examination when diagnosing BA. The BA diagnostic score based on GGT, gallbladder abnormalities and the TC sign shows satisfactory discrimination abilities in BA.

Low gamma-glutamyl transpeptidase levels at presentation are associated with severity of liver illness and poor outcome in biliary atresia

“…The significant GGT elevation in BA has been widely cognized and used in screening and diagnosis of BA (6,7,14,(17)(18)(19). Patients with normal or minimally elevated GGT are vulnerable to being delayed in the diagnosis.…”

“…The serum level of gamma-glutamyl transpeptidase (GGT) in most patients with biliary atresia (BA) is significantly increased, which plays an important role in the differential diagnosis of neonatal cholestatic disorders (1)(2)(3)(4)(5)(6)(7). However, some neonates initially presenting with normal or minimally elevated GGT levels are eventually, and sometimes unexpectedly, confirmed to have BA (8,9).…”

Progress in Biomarkers Related to Biliary Atresia

“…Recently, Weng et al . 74 conducted a multicenter study that divided patients into different age groups. The cut-off value of GGT in patients younger than 30 days was reported in this study.…”

Study on Etiological Shunting of Neonatal Cholestasis by High-Frequency Ultrasound Combined with Clinical Indicators

“…Series literatures had showed its high value for the diagnosis of BA [7,15,16]. But there was no clear consensus on where and how to measure the TC, as well as the cut-off value [17,18]. There were two common sites for TC measurement: the maximum anteroposterior diameter of the proliferative brous cord in the porta hepatis at a cut-off of > 3-4 mm [14,19], or ATRPV excluding the right HA with a cut-off value as low as 2 mm [5,17,20,21].…”