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Liu T, Zhao J, Feng JY, Lu Y, Sheps JA, Wang RX, Han J, Ling V, Wang JS. Neonatal Dubin-Johnson Syndrome and its Differentiation from Biliary Atresia. J Clin Transl Hepatol 2023; 11:163-173. [PMID: 36406324 PMCID: PMC9647112 DOI: 10.14218/jcth.2021.00460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/18/2022] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS The aim was to determine if liver biochemistry indices can be used as biomarkers to help differentiate patients with neonatal Dubin-Johnson syndrome (nDJS) from those with biliary atresia (BA). METHODS Patients with genetically-confirmed nDJS or cholangiographically confirmed BA were retrospectively enrolled and randomly assigned to discovery or verification cohorts. Their liver chemistries, measured during the neonatal period, were compared. Predictive values were calculated by receiver operating characteristic curve analysis. RESULTS A cohort of 53 nDJS patients was recruited, of whom 13 presented with acholic stools, and 14 underwent diagnostic cholangiography or needle liver biopsy to differentiate from BA. Thirty-five patients in the cohort, with complete biochemical information measured during the neonatal period, were compared with 133 infants with cholangiographically confirmed BA. Total and direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bile acids, alkaline phosphatase, and gamma-glutamyl transferase were significantly lower in nDJS than in BA. In the discovery cohort, the areas under the curve for ALT and AST were 0.908 and 0.943, respectively. In the validation cohort, 13/15 patients in the nDJS group were classified as nDJS, and 10/53 in the BA control group were positive (p<0.00001) with an ALT biomarker cutoff value of 75 IU/L. Thirteen of 15 patients were classified as nDJS and none were classified positive in the BA group (13/15 vs. 0/53, p<0.00001) with an AST cutoff of 87 IU/L. CONCLUSIONS Having assembled and investigated the largest cohort of nDJS patients reported to date, we found that nDJS patients could be distinguished from BA patients using the serum AST level as a biomarker. The finding may be clinically useful to spare cholestatic nDJS patients unnecessary invasive procedures.
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Affiliation(s)
- Teng Liu
- The Center for Pediatric Liver Diseases, Children’s Hospital of Fudan University, Shanghai, China
- Correspondence to: Teng Liu and Jian-She Wang, The Center for Pediatric Liver Diseases, Children’s Hospital of Fudan University, NO. 399 Wanyuan Road, Minhang District, Shanghai 201102, China. ORCID: https://orcid.org/0000-0002-0858-2151 (TL), https://orcid.org/0000-0003-0823-586X (JSW). Tel: +86-21-64931171, E-mail: (TL), (JSW)
| | - Jing Zhao
- The Center for Pediatric Liver Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Jia-Yan Feng
- The Department of Pathology, Children’s Hospital of Fudan University, Shanghai, China
| | - Yi Lu
- The Center for Pediatric Liver Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | | | - Ren-Xue Wang
- BC Cancer Agency, Vancouver, British Columbia, V5Z 1L3, Canada
| | - Jun Han
- University of Victoria-Genome BC Proteomics Center, University of Victoria, Victoria, British Columbia, V8Z 7X8, Canada
| | - Victor Ling
- BC Cancer Agency, Vancouver, British Columbia, V5Z 1L3, Canada
| | - Jian-She Wang
- The Center for Pediatric Liver Diseases, Children’s Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- Correspondence to: Teng Liu and Jian-She Wang, The Center for Pediatric Liver Diseases, Children’s Hospital of Fudan University, NO. 399 Wanyuan Road, Minhang District, Shanghai 201102, China. ORCID: https://orcid.org/0000-0002-0858-2151 (TL), https://orcid.org/0000-0003-0823-586X (JSW). Tel: +86-21-64931171, E-mail: (TL), (JSW)
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