Peritoneal fluid bilirubin to serum bilirubin ratio for the diagnosis of bile leaks in orthotopic liver transplant recipients.

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  • Author(s): DeBenedet AT;DeBenedet AT; Scheiman JM; Elta GH; Elmunzer BJ
  • Source:
    Digestive diseases and sciences [Dig Dis Sci] 2013 Oct; Vol. 58 (10), pp. 3044-8. Date of Electronic Publication: 2013 Jun 29.
  • Publication Type:
    Journal Article; Research Support, N.I.H., Extramural
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Springer Science + Business Media Country of Publication: United States NLM ID: 7902782 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-2568 (Electronic) Linking ISSN: 01632116 NLM ISO Abbreviation: Dig Dis Sci Subsets: MEDLINE
    • Publication Information:
      Publication: 2005- : New York, NY : Springer Science + Business Media
      Original Publication: New York, Plenum Pub. Corp.
    • Subject Terms:
      Liver Transplantation*; Ascitic Fluid/*metabolism ; Biliary Tract Diseases/*diagnosis ; Biliary Tract Diseases/*metabolism ; Bilirubin/*metabolism; Adult ; Aged ; Bile Ducts/injuries ; Biomarkers/metabolism ; Case-Control Studies ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Humans ; Male ; Middle Aged ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Transplantation
    • Abstract:
      Background: A peritoneal fluid-to-serum bilirubin ratio (FSBR) of >5 has been shown to be accurate for the detection of bile leaks in post-cholecystectomy and trauma patients; however, there are no studies evaluating the accuracy of this threshold ratio in orthotopic liver transplant (OLT) recipients.
      Methods: We performed a nested case-control analysis to determine the optimal FSBR threshold for diagnosing bile leaks in OLT recipients and the relationship between FSBR and likelihood of bile leak. Adult OLT patients undergoing ERCP for suspected bile leak were divided into 2 groups: those with cholangiographic evidence of a bile leak and those without evidence of leak. Of 57 included patients, 37 were found to have a bile leak on cholangiogram (64.9 %).
      Results: We found a relationship between higher FSBR and the presence of a bile leak (OR 2.84, 95 % CI 1.37-5.88, p = 0.005). A FSBR of >3.25 produced the optimal sensitivity and specificity for identifying bile leaks in OLT recipients (area under ROC curve 0.8865, sensitivity 72.97 %, specificity 95.00 %).
      Conclusions: We conclude FSBR is an easily accessible, moderately accurate test to diagnose bile leaks in liver transplant recipients. This test can inform clinical decision-making with regard to the utilization of ERCP in lower suspicion transplant recipients with a suspected bile leak.
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    • Grant Information:
      5T32DK062708-09 United States DK NIDDK NIH HHS; UL1RR024986 United States RR NCRR NIH HHS
    • Accession Number:
      0 (Biomarkers)
      RFM9X3LJ49 (Bilirubin)
    • Publication Date:
      Date Created: 20130702 Date Completed: 20131203 Latest Revision: 20211021
    • Publication Date:
      20221213
    • Accession Number:
      10.1007/s10620-013-2730-x
    • Accession Number:
      23812826