Clin Pediatr Surg | Volume 1, Issue 1 | Review Article | Open Access

Possible Risk Factors for Short-term Massive Gastrointestinal Bleeding in Patients of Biliary Atresia after Kasai Portoenterostomy

Kai LI1#, Gongbao LIU1#, Shan ZHENG1*, Weili YAN2*, Xuexin LU1, Zhen SHEN1, Wei YAO1, Qilei HAN1 and Ying WU1

1Department of Pediatric Surgery, Children’s Hospital of Fudan University, China
2Department of Clinical Epidemiology, Children’s Hospital of Fudan University, China

*Correspondance to: Shan ZHENG 

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Background: Short-Term Massive Gastrointestinal Bleeding (STMGB) after Kasai portoenterostomy 
is rarely happened but life-threatening in patients of biliary atresia. To find out risk factors and to 
predict risk is of importance.
Methods: Thirteen patients in bleeding group were those who presented STMBG in our institution 
from 2010-2016. Forty-one patients in control group were biliary atresia patients without STMGB 
in the same institution, and were chosen using propensity score according to a ratio of 4:1. Stepwise 
logistic regression model was performed to identify predictive risk factors of STMGB. ROC analysis 
was performed and point estimation and 95% CI of AUC were reported as evaluation of the accuracy 
of the fitted predictive model.
Results: STMGB occurred at an average of 13.70 d ± 4.12 d post-operatively. Eight cases needed 
blood transfusion from 75 ml to 900 ml. Three cases died. Stepwise logistic regression analysis 
identified four significant predictors, including the change in direct bilirubin level before and after 
surgery (OR=2.42, 95% CI: 1.21-4.87), as well as fever after surgery (OR=5.10, 95% CI: 0.69-37.5), 
WBC counts (OR=1.42 95% CI: 1.05-1.90), and platelet count (OR=0.99, 95% CI: 0.98-1.00) on 
postoperative day 12. The model established in study explained 42.8% of the variation of outcome 
risk (P<0.0001, AUC=0.883, 95% CI: 0.72-1.00).
Conclusion: STMGB is often seen around 13 days after KP. Sharp drop of bilirubin, postoperative 
fever, increased WBC and decreased platelet count on postoperative day 12 are identified as possible 
risk factors. The model established in this study has the potential of becoming a good tool to predict 
STMGB, but further studies are expected


Biliary atresia; Massive gastrointestinal bleeding; Post-kasai procedure; Risk factors


LI K, LIU G, ZHENG S, YAN W, LU X, SHEN Z,et al. Possible Risk Factors for Short-Term Massive Gastrointestinal Bleeding in Patients of Biliary Atresia after Kasai Portoenterostomy. Clin Pediatri Surg. 2020;1(1):1002.

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