Development of a nomogram for predicting 2-year native liver survival in biliary atresia using dynamic liver function indicators

Bingliang Li^1,2Hongxia Ren^1*

• ¹Department of neonatal surgery, Shanxi Provincial Children's Hospital, Taiyuan, China
• ²Department of Pediatrics, 山西医科大学, Taiyuan, China

Objectives: To develop and validate a nomogram based on dynamic liver function indexes for predicting native liver survival (NLS) in children with biliary atresia (BA) at 2 years post-Kasai surgery, providing clinicians with a basis for individualized treatment decisions and optimizing early intervention strategies for high-risk children. Methods: Children with type III BA were categorized by their 2-year NLS status.Univariate and multivariate logistic regression analyses were performed to identify predictors of NLS and to construct a nomogram model. Model performance was evaluated using internal bootstrap validation (1,000 resamples) and a training–test split (7:3), with discrimination assessed by the area under the receiver operating characteristic curve (AUC) and calibration by calibration curves. Results: A total of 134 children with type III BA were included. Univariate analysis identified significant associations between prognosis and the following: age at surgery, jaundice clearance failure, liver fibrosis stage, and 3-month postoperative levels of gamma-glutamyl transpeptidase (GGT), serum albumin (ALB), and aspartate aminotransferase and platelet ratio index (APRI) (all P < 0.05). Multivariate analysis established these independent predictors: liver fibrosis stage F4 (OR=3.418, 95% CI: 1.745-6.695), APRI at 3 months (OR=2.285, 95% CI: 1.175-4.445), age at surgery (OR=1.773, 95% CI: 1.192-2.637), GGT at 3 months (OR=1.942, 95% CI: 1.211-3.117), ALB at 3 months (OR=0.948, 95% CI: 0.916-0.981), and jaundice clearance failure (OR=2.437, 95% CI: 1.275-4.657). The resulting nomogram demonstrated stable performance across age subgroups (AUC=0.926 for ≤60 days; AUC=0.867 for >60 days). In the training set, the AUC was 0.872 (95% CI: 0.813-0.931), with sensitivity of 90.7% and specificity of 78.8%. The model showed excellent generalizability in the independent test set (AUC=0.971). Conclusions: This study developed and validated a nomogram integrating dynamic liver function indicators, effectively predicting 2-year NLS in children with BA. The model provides a reliable quantitative basis for individualized treatment decisions and early intervention, with strong clinical This is a provisional file, not the final typeset article applicability, particularly in resource-limited settings. It offers a foundation for optimizing early intervention strategies for high-risk children.