Factores asociados a mortalidad en pacientes pediátricos con atresia de vías biliares en un hospital de tercer nivel en Ecuador.

Abstract

Objective: To determine factors associated with mortality in pediatric patients with biliary atresia at a tertiary care hospital in Ecuador. Methods: An observational, analytical, retrospective study was conducted in patients diagnosed with BA between 2012 and 2025. Continuous variables were expressed as median and interquartile range (IQR). Associations were assessed using bivariate analysis, estimating odds ratios (OR) with 95% confidence intervals (95% CI), considering p < 0.05 as statistically significant. Results: A total of 37 patients were included, with an overall mortality rate of 38%. Restoration of bile flow was associated with lower mortality, whereas absence of bile flow restoration was associated with the outcome (OR 0.03; 95% CI: 0.002–0.68; p = 0.005). Coagulopathy (OR 9.0; 95% CI: 1.96–41.37; p = 0.005) and sepsis (OR 6.88; 95% CI: 1.48–32.01; p = 0.017) were significantly associated with mortality. A PELD score ≥35 showed a strong association with mortality (OR 47.0; 95% CI: 2.40–918.0; p < 0.001). Simple cholangitis showed a non-significant trend toward higher mortality, whereas recurrent cholangitis occurred exclusively in survivors. Conclusions: Mortality in BA is associated with progression to advanced liver disease, failure of bile flow restoration, and infectious and systemic complications. A PELD score ≥35 at final assessment was more frequently observed in patients who died, reflecting advanced hepatic dysfunction. These findings highlight the importance of timely diagnosis, early surgical intervention, infection control, and improved access to pediatric liver transplantation.