Analysis Of Factors Related To Cholangitis After Kasai Procedure For Biliary Atresia

Objective: To explore the clinical characteristics and the independent risk factors of early and frequent cholangitis after Kasai operation for biliary atresia,and establish a prediction model based on the independent risk factors,so as to provide a tool for evaluating the postoperative cholangitis.Methods: Retrospective analysis was used to collect the data of children who were diagnosed as "cholangitis after Kasai operation" in the Second Department of General Surgery in Shenzhen Children’s Hospital from January 2016 to June 2022.A total of 93 cases were screened according to the exclusion criteria.The basic information of the children,age at Kasai operation,preoperative bilirubin,postoperative symptoms,condition at the onset of cholangitis,biochemical indicators and recovery were collected in detail.The patients were divided into groups on the basis of the time and frequency of cholangitis attack,and the related risk factors were processed by univariate analysis,meanwhile the independent risk factors of early and frequent cholangitis were screened by multivariate logistic regression analysis with significantly different variables,and the prediction model was established to evaluate the risk of early or multiple occurrence of cholangitis in children.Results: 1.In the groups based on the time of attack onset: univariate analysis demonstrated that there were statistical differences in the age of operation,preoperative nutritional risk,postoperative liver function recovery,postoperative jaundice clearance,and bile acid at the onset of cholangitis between the early onset group and the late onset group(P<0.05).The binary logistic regression showed that the age of the operation day(OR=0.969,P=0.025),preoperative nutritional risk status(OR=0.178,P=0.006),and postoperative liver function recovery(OR=3.619,P=0.041)were the independent risk factors for early-onset cholangitis.The prediction model was established and the ROC curve was drawn.The area under the curve(AUC)was 0.850.Meanwhile the R language was used to draw the nomogram and calibration curve to visualize it.2.In the groups based on the frequency of incidence,the univariate analysis of children with cholangitis in the frequent group and the incidental group indicated that there were statistical differences in preoperative GGT,preoperative nutritional risk,postoperative liver function recovery,postoperative jaundice clearance,and CRP at the time of cholangitis attack(P<0.05).In binary logistic regression,preoperative nutritional risk and postoperative liver function recovery were independent risk factors for recurrent cholangitis.The prediction model was established based on that and ROC curve was drawn,with AUC of 0.913.Conclusion: Children with early operative age,high preoperative nutritional risk and poor postoperative liver function recovery are prone to gain cholangitis earlier,high preoperative nutritional risk and poor postoperative liver function recovery lead to frequent cholangitis.It’s an effective way to establish the prediction models respectively,which may provide new possibilities for clinical prediction and improvement of the prognosis of children.