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Infant Stool Color Card Screening Helps Reduce the Hospitalization Rate and Mortality of Biliary Atresia

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ABSTRACT

Biliary atresia (BA) is a significant liver disease in children. Since 2004, Taiwan has implemented a national screening program that uses an infant stool color card (SCC) for the early detection of BA. The purpose of this study was to examine the outcomes of BA cases before and after the launch of this screening program. The objectives of this study were to evaluate the rates of hospitalization, liver transplantation (LT), and mortality of BA cases before and after the program, and to examine the association between the hospitalization rate and survival outcomes.

This was a population-based cohort study. BA cases born during 1997 to 2010 were identified from the Taiwan National Health Insurance Research Database. Sex, birth date, hospitalization date, LT, and death data were collected and analyzed. The hospitalization rate by 2 years of age (Hosp/2yr) was calculated to evaluate its association with the outcomes of LT or death.

Among 513 total BA cases, 457 (89%) underwent the Kasai procedure. Of these, the Hosp/2yr was significantly reduced from 6.0 to 6.9/case in the earlier cohort (1997–2004) to 4.9 to 5.3/case in the later cohort (2005–2010). This hospitalization rate reduction was followed by a reduction in mortality from 26.2% to 15.9% after 2006. The Cox proportional hazards model showed a significant increase in the risk for both LT (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.10–1.18) and death (HR = 1.05, 95% CI = 1.01–1.08) for each additional hospitalization. A multivariate logistic regression model found that cases with a Hosp/2yr >6 times had a significantly higher risk for both LT (adjusted odds ratio [aOR] = 4.35, 95% CI = 2.82–6.73) and death (aOR = 1.75, 95% CI = 1.17–2.62).

The hospitalization and mortality rates of BA cases in Taiwan were significantly and coincidentally reduced after the launch of the SCC screening program. There was a significant association between the hospitalization rate and final outcomes of LT or death. The SCC screening program can help reduce the hospitalization rate and mortality of BA cases and bring great financial benefit.

No MeSH data available.


Related in: MedlinePlus

The receiver-operating characteristic curve for predicting the survival outcomes of LT, death, and LT or death in BA cases after the Kasai procedure. BA = biliary atresia, LT = liver transplantation.
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Figure 1: The receiver-operating characteristic curve for predicting the survival outcomes of LT, death, and LT or death in BA cases after the Kasai procedure. BA = biliary atresia, LT = liver transplantation.

Mentions: Based on the ROC curve, the optimal cutoff value for Hosp/2yr as an indicator for LT was projected to be 5.5 times per case, which yielded a sensitivity of 74.6% and a specificity of 64.8%, with an area under the curve (AUC) of 74.8% (95% confidence interval [CI] = 69.2%–77.9%; Appendix 1 and Figure 1). The AUC, sensitivity, and specificity of Hosp/2yr as an indicator for death were not as good as the values for LT, but they still reached significance (Appendix 1). The combined model increased the specificity for “either LT/death” to 77.6%, with a sensitivity of 62.4%, and the AUC was 74.8% (95% CI: 70.4%–79.3%; Appendix 1 and Figure 1). Based on the ROC results, we chose 6 times as the cutoff value for Hosp/2yr to predict the probability or final outcome.


Infant Stool Color Card Screening Helps Reduce the Hospitalization Rate and Mortality of Biliary Atresia
The receiver-operating characteristic curve for predicting the survival outcomes of LT, death, and LT or death in BA cases after the Kasai procedure. BA = biliary atresia, LT = liver transplantation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998398&req=5

Figure 1: The receiver-operating characteristic curve for predicting the survival outcomes of LT, death, and LT or death in BA cases after the Kasai procedure. BA = biliary atresia, LT = liver transplantation.
Mentions: Based on the ROC curve, the optimal cutoff value for Hosp/2yr as an indicator for LT was projected to be 5.5 times per case, which yielded a sensitivity of 74.6% and a specificity of 64.8%, with an area under the curve (AUC) of 74.8% (95% confidence interval [CI] = 69.2%–77.9%; Appendix 1 and Figure 1). The AUC, sensitivity, and specificity of Hosp/2yr as an indicator for death were not as good as the values for LT, but they still reached significance (Appendix 1). The combined model increased the specificity for “either LT/death” to 77.6%, with a sensitivity of 62.4%, and the AUC was 74.8% (95% CI: 70.4%–79.3%; Appendix 1 and Figure 1). Based on the ROC results, we chose 6 times as the cutoff value for Hosp/2yr to predict the probability or final outcome.

View Article: PubMed Central - PubMed

ABSTRACT

Biliary atresia (BA) is a significant liver disease in children. Since 2004, Taiwan has implemented a national screening program that uses an infant stool color card (SCC) for the early detection of BA. The purpose of this study was to examine the outcomes of BA cases before and after the launch of this screening program. The objectives of this study were to evaluate the rates of hospitalization, liver transplantation (LT), and mortality of BA cases before and after the program, and to examine the association between the hospitalization rate and survival outcomes.

This was a population-based cohort study. BA cases born during 1997 to 2010 were identified from the Taiwan National Health Insurance Research Database. Sex, birth date, hospitalization date, LT, and death data were collected and analyzed. The hospitalization rate by 2 years of age (Hosp/2yr) was calculated to evaluate its association with the outcomes of LT or death.

Among 513 total BA cases, 457 (89%) underwent the Kasai procedure. Of these, the Hosp/2yr was significantly reduced from 6.0 to 6.9/case in the earlier cohort (1997–2004) to 4.9 to 5.3/case in the later cohort (2005–2010). This hospitalization rate reduction was followed by a reduction in mortality from 26.2% to 15.9% after 2006. The Cox proportional hazards model showed a significant increase in the risk for both LT (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.10–1.18) and death (HR = 1.05, 95% CI = 1.01–1.08) for each additional hospitalization. A multivariate logistic regression model found that cases with a Hosp/2yr >6 times had a significantly higher risk for both LT (adjusted odds ratio [aOR] = 4.35, 95% CI = 2.82–6.73) and death (aOR = 1.75, 95% CI = 1.17–2.62).

The hospitalization and mortality rates of BA cases in Taiwan were significantly and coincidentally reduced after the launch of the SCC screening program. There was a significant association between the hospitalization rate and final outcomes of LT or death. The SCC screening program can help reduce the hospitalization rate and mortality of BA cases and bring great financial benefit.

No MeSH data available.


Related in: MedlinePlus