Document Type : original article

Authors

• Forogh Ali Akbarniya Omran ¹
• Mohammadali Kiani ²
• Hamid Ahanchian ³
• Seyed Ali Jafari ²
• Maryam Khalesi ⁴
• hamidreza kianifar ²

¹ Subspecialty in Pediatric Gastroenterology, Mazandaran University of Medical Sciences, Sari, Iran.

² Professor of Pediatrics Gastroenterology, Department of Pediatrics, Akbar hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

³ Professor of Pediatric Immonology, Subspecialty in Allergy, Asthma and Clinical Immunology, Pediatric Allergy Fellowship, Mashhad University of Medical Sciences, Mashhad, Iran.

⁴ Associate Professor of Pediatrics Gastroenterology, Department of Pediatrics, Akbar hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background: Neonatal cholestasis is one of the important liver diseases in children; and infants are more prone to it due to the immaturity of the liver. It appears due to several reasons and its treatment is determined based on its cause. If the cause is not diagnosed in time and rapid treatment is not adopted, it will result in irreparable complications. Biliary atresia is the main cause of this disease and the most common symptom of the need for liver transplantation in children, which requires early diagnosis as a prognostic factor of the disease and its immediate differentiation from other causes of cholestasis. Considering the use of new diagnostic biomarkers, the present study was conducted with the aim of investigating the diagnostic value of serum interleukin 33 (IL-33) in infants with cholestasis and its relationship with clinical and laboratory data.
Methods: This research is a cross-sectional study, conducted on infants referred to the gastroenterology clinic of Akbar Hospital in Mashhad during the years 2021 and 2022. According to the entry and exit criteria, cholestatic infants were included in the study in two groups with and without biliary atresia along with the control group (healthy infants). The basic information, clinical manifestations, and laboratory findings of infants were collected through a researcher-made checklist; and recorded in SPSS software version 24. Data description and analyses were done using descriptive indices, statistical tests, regression methods, and rock curve at a significance level of less than 0.05.
Results: The participants included 78 infants with an average age of 2.80 ± 1.42 months, enrolled in three groups (26 cases each). The intervention groups consisted of patients with cholestasis with and without biliary atresia; and there was one group of healthy infants as the control group. The serum level of IL-33 biomarker was significantly higher in patients with biliary atresia than in patients without atresia (p=0.014); and in both groups, it was higher than that in the control group (p=0.001). The serum level of IL-33 had a significant positive correlation with laboratory indicators of AST, ALT and GGT (p<0.05).  Interleukin-33 serum level at the cut-off point of 275 pg/ml can diagnose biliary atresia with a sensitivity of 84.6 and a specificity of 92.3%, so that the probability of biliary atresia in infants with IL-33 ≥ 275 is reported to be twice as often higher than that in infants with A serum levels lower than this value (p=0.011).
Conclusion: The serum level of interleukin 33 was significantly higher in patients with biliary atresia than in patients without atresia as well as in healthy infants; and at the determined cut-off point, it had a favorable diagnostic value for identifying infants with biliary atresia.

Keywords

• Biliary atresia
• Diagnostic value
• Interleukin 33 serum level
• Neonatal cholestasis