The preoperative lymphocyte ratio and postoperative C-reactive protein are related to the surgical outcome in biliary atresia: an analysis of serial ubiquitous markers of inflammation

Pediatr Surg Int. 2022 Dec;38(12):1777-1783. doi: 10.1007/s00383-022-05231-x. Epub 2022 Sep 13.


Purpose: Various prognostic predictors for biliary atresia (BA) have been identified. This study aimed to evaluate the serial changes in the preoperative and postoperative ubiquitous inflammatory biomarkers and their relationship with the outcomes in patients with BA.

Patients and methods: Forty-three BA patients were retrospectively reviewed to investigate serial levels of ubiquitous inflammatory biomarkers, including C-reactive protein (CRP) and lymphocyte ratio, and outcomes. The patients with BA were divided based on their outcomes into two prognostic groups: the native liver survivor group (n = 30) and the survivors with living-donor liver transplant group (n = 13).

Results: The area under the receiver operating characteristic (ROC) curve analysis showed that a preoperative lymphocyte ratio of < 61% and CRP value > 0.1 mg/dl predicted a poor outcome. In the ROC curve analysis, the timing of reaching the cut-off value of CRP after Kasai portoenterostomy was postoperative day (POD) 57. The third postoperative week, which was the timing of the discontinuation of steroid therapy, was the branchpoint of inflammatory markers between the two prognostic groups.

Conclusion: The POD 57 CRP level predicts the surgical outcome of Kasai portoenterostomy. The postoperative anti-inflammatory management of BA can be monitored by the ubiquitous inflammatory biomarkers CRP and the preoperative lymphocyte ratio.

Keywords: Biliary atresia; C-reactive protein; Kasai portoenterostomy; Lymphocyte ratio; Native-liver survival rate.

MeSH terms

  • Biliary Atresia* / surgery
  • Biomarkers
  • C-Reactive Protein
  • Humans
  • Infant
  • Inflammation / etiology
  • Liver Transplantation*
  • Living Donors
  • Lymphocytes
  • Portoenterostomy, Hepatic / adverse effects
  • Retrospective Studies
  • Treatment Outcome


  • C-Reactive Protein
  • Biomarkers