Page 86 - Ebook-Book JCMS 2025

Characteristics and the Associated Factors of Infections and
Infection-associated Clinical Outcomes in Children Dianosed
with Biliary Atresia and Cirrhosis
Varissara Kaewchaivijit, Pornthep Tanpowpong*, Songpon Getsuwan, Sophida Boonsathorn, Chatmanee
Lertudomphonwanit, Suporn Treepongkaruna
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
*Corresponding Author E-mail: pornthep.tan@mahidol.ac.th
Background: Abstract
Background: Biliary atresia (BA) is a common cause of cirrhosis in children, and serious
bacterial infection can contribute to unsatisfactory outcomes in children with BA with
cirrhosis. We aimed to study the incidence, characteristics, associated factors, and
outcomes of infection in these children.
Methods: Children with cirrhosis due to BA aged <18 years between 2014-2023 were systematically
reviewed. We analyzed the data to determine the associated factors and clinical outcomes
of proven/suspected bacterial infection.
Results: A total of 150 consecutive patients were included. Ninety-four patients (62.7%) had a history
of infection with a total of 222 infection episodes, defined as proven/suspected bacterial
infection in 143 episodes (64.4%). The most common causes of bacterial infection (n=161)
were acute cholangitis (39.7%), bacteremia (22.4%) and infected biloma (9.9%). Presumed
viral infection (n=88) included gastroenteritis (25%), followed by upper respiratory tract
infection (23.8%). Proven/suspected bacterial infection increased in children with higher
pediatric end-stage liver disease (PELD) score and with higher bilirubin level at the first
visit to our center. The CRP cutoff of 31 mg/L provided a sensitivity of 75.4%, specificity
of 68.2% and area under the ROC curve of 0.80 (95%CI: 0.69-0.90) to distinguish between
proven/suspected bacterial infection vs. presumed viral infection. In our cohort, 54%
underwent LT, 24% were alive with native liver, 8% died. and 14% lost to follow up. Proven/
suspected bacterial infection showed an adjusted hazard ratio of 1.88 (95%CI: 1.51, 2.33)
for a lower chance for native liver survival (i.e., more LT or death).
Conclusions: Infection is common in children with cirrhosis due to BA. Clinical and laboratory data,
such as CRP, are useful in differentiating proven/suspected bacterial infection with other
infections. Bacterial infection decreased the probability of native liver survival therefore
proper management and prevention of bacterial infection may decrease chances for LT and/
or improve survival.
84 Joint Conference in Medical Sciences 2025