Serum matrix metalloproteinase-7 (MMP-7) as a Biomarker for differentiating biliary atresia from neonatal hepatitis: evidence synthesis through systematic review and meta-analysis.

Purpose: Biliary atresia (BA) requires timely differentiation from neonatal hepatitis (NH) and early surgery for optimal outcomes. This systematic review and meta-analysis evaluated the diagnostic performance of serum Matrix metalloproteinase-7 (MMP-7) as a biomarker for differentiating BA from NH.

Methods: The PRISMA-DTA compliant synthesis was based upon primary data available till date, assessing the role of MMP-7 in diagnosing BA. Studies reporting diagnostic accuracy metrics were included. Pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR) and area under the summary receiver operating characteristic (SROC) curve were calculated.

Results: Twenty-four studies (7298 participants: 3301 BA, 2,930 NH and 1067 controls) were analysed. The serum MMP-7 values ranged from 1.2 to 10.3 ng/mL in controls, 1.88-12.57 ng/mL in NH and 10.26-121.1 ng/mL in BA, with interquartile ranges spanning 1.08-25.3, 0.78-34.0 and 3.38-368.0 ng/mL, respectively. Median serum MMP-7 levels were consistently higher in BA vis-a-vis NH and the control population. Pooled sensitivity and specificity of MMP-7 as a diagnostic biomarker were 0.94 and 0.88, respectively. The DOR was 120.09 and the SROC AUC was 0.967.

Conclusion: Serum MMP-7 demonstrates excellent diagnostic accuracy for differentiating BA from NH. Further research should focus on assay standardization and age-specific reference ranges to optimize clinical utility.