Preoperative Serum IL-12p40 Is a Potential Predictor of Kasai Portoenterostomy Outcome in Infants with Biliary Atresia

The standard-of-care treatment for biliary atresia (BA) is surgical restoration of bile flow by Kasai portoenterostomy. We aimed to study serum interleukin- (IL-) 12p40, a natural antagonist for the proinflammatory IL-12p70, and its relation to surgical outcomes of BA. The study included 75 infants with neonatal cholestasis: BA group (n=25), non-BA cholestasis group (n=30), and neglected BA group (n=20), in addition to thirty healthy neonates serving as controls. IL-12p40 was measured by ELISA in all individuals and a second assessment was performed 3 months postoperatively in the BA group. The surgical outcomes were classified as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin > 2 mg/dl). IL-12p40 was higher in BA compared to that in the non-BA and control groups (P values were 0.036 and <0.0001, resp.) but comparable to that in the neglected BA group. Preoperative IL-12p40 levels in BA patients were significantly higher in successful Kasai compared with failed Kasai and a cutoff level of 547.47 pg/ml could predict the successful outcome with 87.5% sensitivity and 82.4% specificity. Three-month postoperative IL-12p40 tended to decrease in both the successful and failed groups. In conclusion, preoperative serum IL-12p40 is a potential predictor of Kasai outcome. Serial postoperative measurements may anticipate the failure of an initially successful operation, hence the need for liver transplantation

Preoperative Serum IL-12p40 Is a Potential Predictor of Kasai Portoenterostomy Outcome in Infants with Biliary Atresia

The standard-of-care treatment for biliary atresia (BA) is surgical restoration of bile flow by Kasai portoenterostomy. We aimed to study serum interleukin-(IL-) 12p40, a natural antagonist for the proinflammatory IL-12p70, and its relation to surgical outcomes of BA. The study included 75 infants with neonatal cholestasis: BA group (n = 25), non-BA cholestasis group (n = 30), and neglected BA group (n = 20), in addition to thirty healthy neonates serving as controls. IL-12p40 was measured by ELISA in all individuals and a second assessment was performed 3 months postoperatively in the BA group. The surgical outcomes were classified as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin &gt; 2 mg/dl). IL-12p40 was higher in BA compared to that in the non-BA and control groups (P values were 0.036 and &lt;0.0001, resp.) but comparable to that in the neglected BA group. Preoperative IL-12p40 levels in BA patients were significantly higher in successful Kasai compared with failed Kasai and a cutoff level of 547.47 pg/ml could predict the successful outcome with 87.5% sensitivity and 82.4% specificity. Three-month postoperative IL-12p40 tended to decrease in both the successful and failed groups. In conclusion, preoperative serum IL-12p40 is a potential predictor of Kasai outcome. Serial postoperative measurements may anticipate the failure of an initially successful operation, hence the need for liver transplantation

Serum YKL-40 (Chitinase-3-Like Protein 1) Compared to APRI and FIB-4 in Predicting Liver Fibrosis in Children with Chronic Hepatitis C

Background: Liver fi brosis is a critical factor for the treatment policy and its outcome in chronic hepatitis C virus (HCV) infection. Although liver biopsy represents the gold standard for evaluating fibrosis, it remains an invasive procedure with inherent risks. Thus, it cannot be performed frequently to monitor therapeutic outcomes specially in the pediatric population. For that, developing a non-invasive test that can predict liver fi brosis represents a growing medical need.Objectives: to investigate serum levels of YKL-40 and their relation to liver fi brosis in children with chronic HCV.Methods: Serum YKL-40 was measured by enzyme linked immunosorbent assay in 40 treatmentnaive children with proved chronic HCV and the levels were compared according to different laboratory and histopathological parameters. Liver histopathological changes were assessed using Ishak score and compared with aspartate transaminase-to-platelet ratio (APRI) and fi brosis-4 (FIB-4) indices as simple non-invasive markers of fi brosis. YKL-40 was measured in a group of 27 age- and sex-matched healthy controls.Results: YKL-40 was signifi cantly higher in patients than in controls (23.79±11.59 ng/ml vs. 17.67±5.49 ng/ml; P = 0.038). YKL-40 (r = 0.36, P = 0.022), but not APRI (r = -0.176, P = 0.328) or FIB-4 (r = -0.202, P = 0.259), had a signifi cant direct correlation with fi brosis stage. YKL-40 at a cutoff level of ≥24.82&nbsp; ng/ml could discriminate patients with signifi cant fi brosis (≥F3 Ishak) with 100% sensitivity and 80%&nbsp; specifi city.Conclusion: YKL-40 signifi cantly correlated with liver fi brosis and could discriminate those with signifi cant fi brosis with acceptable performance.</p