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