Matrix Metalloproteinase-7 as a Diagnostic Marker for Biliary Atresia: a Systematic Review and Meta-analysis

The matrix metalloproteinase-7 (MMP-7) is a promising marker for identification of biliary atresia. We assessed the accuracy and clinical value of MMP-7 for diagnosis of biliary atresia in infants. We searched MEDLINE, Embase, ISI Web of Knowledge, and the Cochrane Library, from inception to December 30, 2020. We included articles written in English, Chinese, or French that investigated MMP-7 for differentiation of biliary atresia infants from those with other form of cholestasis. Two review authors independently assessed eligibility for inclusion, evaluated the methodological quality of included studies, and extracted data to estimate diagnostic accuracy. We calculated individual and pooled sensitivities and specificities. We used I² to test heterogeneity and investigated the source of heterogeneity. Our search identified 4 studies (593 infants). Risk of bias in the included studies was generally low. Bivariate analysis yielded a mean sensitivity of 0.96 (95% CI: 0.93–0.98) and specificity of 0.91 (95% CI: 0.85–0.95). The area under the receiver operating characteristic curve was 0.97 (95% CI: 0.95–0.98). A moderate heterogeneity was found among the included studies as the I² values for sensitivity and specificity were 8.6% (95% CI: 1.5–19.04) and 56.7% (95% CI: 28.91–70.07), respectively. After a sensitivity analysis, there was no change in sensitivity and MMP-7 specificity ranged from 0.91 to 0.93. The serum MMP-7 is a helpful biomarker for diagnosis of biliary atresia in cholestasis infants. Nevertheless, it cannot be recommended as the single definitive test for biliary atresia diagnosis; further primary clinical research is mandatory.

Trial registration: prospero230839