title: Value of Gamma-Glutamyl Transpeptidase for Diagnosis of Biliary Atresia by Correlation With Age.
abstract: The aim of the study was to analyze the value of gamma-glutamyl transpeptidase (GGT) for distinguishing biliary atresia (BA) from non-BA for patients suspected of having neonatal obstructive jaundice by correlation with age.
  
  
  
  From January 2003 to March 2014, cholangiography and/or surgical exploration were undertaken in 1469 patients with suspicion of having neonatal obstructive jaundice. A total of 1338 patients were diagnosed with BA intraoperatively. Preoperative medical records were compared between BA and non-BA patients.
  
  
  
  Preoperative levels of total bilirubin, direct bilirubin, and GGT were significantly higher in the BA group (P < 0.05), whereas the non-BA group had higher alkaline phosphatase levels (P = 0.0003). The area under the receiver operating characteristic curve of total bilirubin, direct bilirubin, GGT, and alkaline phosphatase was 0.584, 0.614, 0.843, and 0.398, respectively. In all age groups (i: 31-60 days; ii: 61-90 days; iii: 91-120 days; iv: ≥121 days), BA groups had higher GGT levels (in IU/L) (i: 725.3 ± 549.9; ii: 927.0 ± 679.8; iii: 1114.3 ± 823.1; iv: 767.5 ± 666.7). The level of GGT in patients with BA younger than 30 days was 834.2 ± 475.3 IU/L. GGT levels had the highest diagnostic value (0.869) in group ii (61-90 days) and the lowest diagnosis value (0.712) in group iv (≥121 days). At a cutoff of >303 IU/L in group ii (61-90 days), GGT had 82.8% sensitivity and 81.6% specificity for the discrimination of BA.
  
  
  
  GGT levels contribute to the diagnosis of BA before 120 days. Age must be considered if using GGT levels as a diagnostic test for BA.
authors.affiliation: *Department of Pediatric Surgery, Children's Hospital of Fudan University, and Key Laboratory of Neonatal Disease, Ministry of Health †Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Chen
authors.forename: Rui
authors.initials: R
authors.lastname: Dong
authors.forename: Zhen
authors.initials: Z
authors.lastname: Shen
authors.forename: Weili
authors.initials: W
authors.lastname: Yan
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001656:Biliary Atresia / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D001663:Bilirubin / Q000097:blood; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000209:etiology; D041781:Jaundice, Obstructive / Q000209:etiology; D008099:Liver / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin