Characteristics of infections and their risk factors in children with biliary atresia.

Henry Shiau, Jeremy M Schraw, Krupa Mysore, Laurel Cavallo, Sanjiv Harpavat, Philip J Lupo, Flor M Munoz, Benjamin L Shneider

Journal: Clinics and research in hepatology and gastroenterology 2023;47(4):102109

PMID: 36882124

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Abstract

BACKGROUND

Children with biliary atresia (BA) may experience various infections (e.g., cholangitis, bacteremia, and viral respiratory infections (VRI)) throughout their disease course. This study aimed to identify and describe these infections and their risk factors for development in children with BA.

METHODS

This retrospective observational study identified infections in children with BA using predefined criteria, including VRI, bacteremia with and without central line (CL), bacterial peritonitis, positive stool pathogens, urinary tract infections, and cholangitis. Infections were identified until liver transplant, death or last follow-up with native liver. Infection-free survival was estimated by Kaplan-Meier analysis. Logistic regression was used to estimate odds of infection per clinical characteristics. Cluster analysis was performed to identify patterns of infection development.

RESULTS

48 of 65 (73.8%) children had ≥1 infection during their disease course (mean length of follow up: 40.2 months). Cholangitis (n = 30) and VRI (n = 21) were most common. Nearly half (45%) of all infections developed within 3-months of Kasai hepatoportoenterostomy. Kasai performed ≥45 days of life was associated with 3.5-fold increased risk of any infection (95% CI 1.2-11.4). Risk of VRI was inversely related to platelet count at 1-month post-Kasai (OR 0.5, 0.19-0.99). Cluster analysis of infectious patterns identified three unique cohorts of patients based on their infection history: no/few infections (n = 18), mostly cholangitis (n = 20) or mixed infections (n = 27).

CONCLUSION

Variability of infection risk exists amongst children with BA. Age at Kasai and platelet count are risk factors for future infections, suggesting that patients with more severe disease are at greater risk. Cirrhosis associated immune deficiency may exist in chronic pediatric liver disease and should be the subject of future investigations in order to optimize outcomes.

Address: Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, U.S.A.. Electronic address: [email protected].; Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, U.S.A.; Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, U.S.A.; Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, U.S.A.; Department of Pediatrics, Section of Infectious Diseases, Molecular Virology and Microbiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, U.S.A.

DOI: 10.1016/j.clinre.2023.102109

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MeSH Terms: Humans, Child, Infant, Biliary Atresia, Prognosis, Liver, Cholangitis, Risk Factors, Retrospective Studies, Treatment Outcome