Abstract
Objectives: Biliary atresia (BA) is a devastating pediatric liver disease. Early diagnosis is important for timely intervention and better prognosis. Using clinical parameters for non-invasive and efficient BA diagnosis, we aimed to establish an artificial neural network (ANN).Methods: A total of 2,384 obstructive jaundice patients from 2012 to 2017 and their 137 clinical parameters were screened for eligibility. A standard binary classification feed-forward ANN was employed. The network was trained and validated for accuracy. Gamma-glutamyl transpeptidase (GGT) level was used as an independent predictor and a comparison to assess the network effectiveness.Results: We included 46 parameters and 1,452 patients for ANN modeling. Total bilirubin, direct bilirubin, and GGT were the most significant indicators. The network consisted of an input layer, 3 hidden layers with 12 neurons each, and an output layer. The network showed good predictive property with a high area under curve (AUC) (0.967, sensitivity 97.2% and specificity 91.0%). Five-fold cross validation showed the mean accuracy for training data of 93.2% and for validation data of 88.6%.Conclusions: The high accuracy and efficiency demonstrated by the ANN model is promising in the noninvasive diagnosis of BA and could be considered as in a low-cost and independent expert diagnosis system.
Highlights
Biliary atresia (BA), a devastating pediatric liver disease, is the major cause of liver transplantation in children [1]
This study aimed to evaluate its effectiveness in BA diagnosis
Patients with obstructive jaundice patients who were suspected of BA, admitted to the surgical department of the Children’s Hospital of Fudan University, and underwent surgical cholangiography from the 2nd of January 2012 to the 30th of November 2017 were enrolled for screening
Summary
Biliary atresia (BA), a devastating pediatric liver disease, is the major cause of liver transplantation in children [1]. Cholangiography and liver biopsy pathology usually show intrahepatic and extrahepatic bile duct obstruction, hilar fiber block, liver inflammation, and fibrosis [2]. Mainly via Kasai portoenterostomy, is the only way to reestablish bile flow in BA [3]. Many BA patients still suffer from progressive liver fibrosis after the Kasai procedure and will eventually need liver transplantation [4]. A Kasai procedure performed within 60 days of birth contributes to a better prognosis in BA patients [9,10,11]. Diagnosis of BA is done by surgical cholangiography and liver biopsy, both of which are invasive procedures with prolonged recovery times
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