ArticleTranslational pediatrics2026
Diagnostic value of routine biochemical markers for biliary atresia in neonates with cholestasis: a retrospective study.
Article in Translational pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Early diagnosis of biliary atresia (BA) is essential for improving outcomes, but distinguishing it from other causes of neonatal cholestasis (NC) remains difficult. This study aimed to evaluate the diagnostic performance of routine biochemical markers in neonates and determine optimal cutoff values for BA. Methods: We retrospectively analyzed 226 neonates with cholestasis admitted between 2018 and 2025. Based on intraoperative cholangiography or clinical follow-up, 53 were diagnosed with BA and 173 with non-BA cholestasis. Baseline characteristics and laboratory parameters were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify independent predictors, with odds ratio (OR) and 95% confidence interval (CI) calculated to quantify the association strength. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cutoff values and evaluate diagnostic performance, including area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Baseline characteristics were comparable between groups (all P>0.05). BA patients had significantly higher gamma-glutamyl transferase (GGT), total bile acid (TBA), and direct bilirubin (DBIL) levels (all P<0.05). Multivariate regression confirmed these as independent BA predictors: GGT (OR =1.007; 95% CI: 1.004-1.009; P<0.001), TBA (OR =1.019; 95% CI: 1.009-1.029; P<0.001), DBIL (OR =1.010; 95% CI: 1.004-1.016; P=0.001). ROC analysis yielded optimal cutoffs: GGT 274.5 U/L (AUC =0.893; 95% CI: 0.843-0.943; sensitivity =90.6%, specificity =75.7%), TBA 67.4 µmol/L (AUC =0.857; 95% CI: 0.802-0.912; sensitivity =83.0%, specificity =75.7%), DBIL 46.2 µmol/L (AUC =0.803; 95% CI: 0.742-0.864; sensitivity =86.8%, specificity =68.8%). Conclusions: GGT, TBA, and DBIL are valuable non-invasive predictors for neonatal BA. The established cutoff values may aid early screening, but prospective multicenter validation is needed before clinical application.
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