Abstract
BACKGROUND: The Kasai procedure is still considered the optimal therapeutic approach for biliary atresia (BA). Nevertheless, the onset of postoperative cholangitis can impede the resolution of jaundice and significantly affect the overall prognosis of the disease. This study aims to develop a nomogram model that precisely forecasted the incidence of cholangitis after the Kasai procedure. METHODS: This study retrospectively collected clinical, preoperative, and postoperative serological data from patients with BA who underwent the Kasai procedure at Tianjin Children's Hospital between January 2017 and November 2023. Utilizing multivariable analysis and logistic regression, a clinical nomogram model was developed to predict the occurrence of primary cholangitis postoperatively. To validate the model's accuracy, data from patients with BA at Xi'an Children's Hospital from January 2018 to November 2019 were employed. RESULTS: We identified two independent predictors, neutrophil ratio post-operative to pre-operative ratio (NEU% PPR) and alkaline phosphatase post-operative to pre-operative ratio (ALP PPR), that were significantly associated with the occurrence of primary cholangitis following the Kasai procedure. These predictors were subsequently utilized to construct a nomogram model. The model exhibited an area under the curve (AUC) value of 0.829, surpassing the predictive capabilities of individual predictors. Additionally, through Kaplan-Meier (KM) analysis, we observed a significant correlation between ALP PPR and the occurrence of postoperative primary cholangitis, further supporting the reliability of our nomogram model. CONCLUSIONS: This study has successfully established a clinical prediction model that can effectively predict the occurrence of primary cholangitis following the Kasai procedure for BA.