Three-color risk stratification for improving the diagnostic accuracy for biliary atresia
Three-color risk stratification for improving the diagnostic accuracy for biliary atresia
复制标题
三色风险分层提高胆道闭锁诊断准确性
DOI：
10.1007/s00330-020-06751-7
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发表时间：
2020-07-01
影响因子：
5.9
通讯作者：
Zhang, Yongjun
中科院分区：
文献类型：
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作者：
Chen, Yan;Zhao, Dongying;Zhang, Yongjun
目的早期鉴别胆道闭锁与其他原因引起的胆汁淤积具有挑战性。我们的目的是制定一个算法与风险分层，以区分胆道闭锁婴儿cholestasis.MethodsIn这项研究中，我们纳入了2个亚组，从2010年1月至2019年4月胆汁淤积的婴儿。前瞻性队列（亚组2）187例患者（107例胆道闭锁和80例无胆道闭锁）进行了声辐射力脉冲弹性成像。逐步回归分析用于确定胆道闭锁的重要预测因素。结果在187例患者中，剪切波速度> 1.35 m/s和三角索征的存在被认为是胆道闭锁的高风险（红色），其中73例（准确率为93.6%）与胆道闭锁。之后，将γ-GT、异常胆囊和粘土便引入算法，并确定了55名中等风险婴儿（黄色），诊断胆道闭锁的准确率为60%。其余54名婴儿被归类为低风险患者（绿色），排除胆道闭锁的准确率为98.1%。通过应用三色风险分层工具，70.6%的患者被确定为胆道闭锁的高风险或低风险（曲线下面积，0.983;敏感性，98.7%;特异性，91.4%）。我们还估计了不同颜色组胆道闭锁的风险，为94.7%（95%CI，94.3-95.5%），红色组为7.2%，（95%CI，6.6-8.3%）在绿色组。结论我们简单的非侵入性方法能够识别胆道闭锁，具有较高的准确性。要点·五个预测因子，即剪切波速度，三角索征，选择γ-谷氨酰转移酶、异常胆囊和粘土样粪便来鉴别胆汁淤积性胆道闭锁。剪切波速度> 1.35 m/s且存在三角索征的患者被认为是胆道闭锁的高危患者，诊断准确率为93.6%。·胆道闭锁的风险为高（红色）、中等（黄色）或低（绿色）。在红色和绿色组中，我们实现了极高的诊断性能（曲线下面积，0.983;灵敏度，98.7%;特异性，91.4%）。
ObjectivesIt is challenging to early differentiate biliary atresia from other causes of cholestasis. We aimed to develop an algorithm with risk stratification to distinguish biliary atresia from infantile cholestasis.MethodsIn this study, we enrolled infants with cholestasis into 2 subgroups from January 2010 to April 2019. A prospective cohort (subgroup 2) of 187 patients (107 with biliary atresia and 80 without biliary atresia) underwent acoustic radiation force impulse elastography. Stepwise regression was used to identify significant predictors of biliary atresia. A sequential algorithm with risk stratification was constructed.ResultsAmong 187 patients, shear wave speed > 1.35 m/s and presence of the triangular cord sign were considered high risk for biliary atresia (red), in which 73 of 78 patients (accuracy of 93.6%) with biliary atresia were identified. Afterwards, γ-GT, abnormal gallbladder, and clay stool were introduced into the algorithm and 55 intermediate-risk infants were identified (yellow) with a diagnostic accuracy of 60% for biliary atresia. Of the remaining 54 infants who were classified as low-risk patients (green), the accuracy for excluding biliary atresia was 98.1%. By applying a three-color risk stratification tool, 70.6% patients were identified as either high risk or low risk for biliary atresia (area under the curve, 0.983; sensitivity, 98.7%; specificity, 91.4%). We also estimated the risk of biliary atresia in different color groups, which was 94.7% (95%CI, 94.3–95.5%) in the red group and 7.2% (95%CI, 6.6–8.3%) in the green group.ConclusionsOur simple noninvasive approach was able to identify biliary atresia with high accuracy.Key Points• Five predictors, namely shear wave speed, triangle cord sign, γ-glutamyl transferase, abnormal gallbladder, and clay stool, were selected to identify biliary atresia in cholestasis.• Shear wave speed > 1.35 m/s and presence of the triangle cord sign were considered high-risk patients with a diagnostic accuracy of 93.6% for biliary atresia.• Risk for biliary atresia was high (red), intermediate (yellow), or low (green). In the red and green group, we achieved an extremely high diagnostic performance (area under the curve, 0.983; sensitivity, 98.7%; specificity, 91.4%).