Impact of bacterial infection on native liver survival in children with cirrhosis due to biliary atresia

Background: Biliary atresia (BA) is a common cause of cirrhosis in children, and serious bacterial infections may worsen clinical outcomes.Purpose: To study the characteristics, associated factors, and outcomes of infections in children with cirrhosis secondary to BA. Methods: A retrospective cohort study was conducted in children aged <18 years with cirrhosis due to BA be tween 2014 and 2023.Patients were categorized as having proven/suspected bacterial infection, presumed viral in fection, or no documented infection.The clinical charac teristics, associated risk factors, predictive models, and native liver survival outcomes, including liver transplan tation (LT) and death, were analyzed.Results: Among 150 children, 94 (62.7%) had 222 infection episodes and 249 had infectionrelated diagnosis.Of the 222 episodes, 143 (64.4%) were classified as proven/ suspected bacterial infections; cholangitis was the most common bacterial diagnosis (39.7%).Univariate analysis showed that proven/suspected bacterial infection was associated with higher pediatric endstage liver disease scores at the first visit and during fever episodes and with higher total and direct bilirubin levels during fever episo des.Creactive protein (CRP) cutoff of 31 mg/L yielded 75.4% sensitivity, 68.2% specificity, and an area under the receiver operating characteristic curve of 0.80 (95% confi dence interval [CI], 0.69-0.90)for distinguishing proven/ suspected bacterial from presumed viral infections.Overall, 54% of patients underwent LT, 24% survived with their native liver, 8% died, and 14% were lost to followup.After adjustment for disease severity and infection history before referral, proven/suspected bacterial infection was associated with lower native liver survival (adjusted hazard ratio, 1.88; 95% CI, 1.51-2.33). Conclusion:Infections are common in children with cirrhosis due to BA. Serum CRP may help distinguish proven/suspected bacterial from other infections.Bac terial infections were associated with lower native liver survival; therefore, appropriate management and preven tion may improve native liver survival.