The clinical diagnosis of biliary atresia (BA) poses challenges, particularly in distinguishing it from cholestasis (CS). Moreover, the prognosis for BA is unfavorable and there is a dearth of effective non-invasive diagnostic models for detection. Therefore, the aim of this study is to elucidate the metabolic disparities among children with BA, CS, and normal controls (NC) without any hepatic abnormalities through comprehensive metabolomics analysis. Additionally, our objective is to develop an advanced diagnostic model that enables identification of BA. The plasma samples from 90 children with BA, 48 children with CS, and 47 NC without any liver abnormalities children were subjected to metabolomics analysis, revealing significant differences in metabolite profiles among the 3 groups, particularly between BA and CS. A total of 238 differential metabolites were identified in the positive mode, while 89 differential metabolites were detected in the negative mode. Enrichment analysis revealed 10 distinct metabolic pathways that differed, such as lysine degradation, bile acid biosynthesis. A total of 18 biomarkers were identified through biomarker analysis, and in combination with the exploration of 3 additional biomarkers (LysoPC(18:2(9Z,12Z)), PC (22:5(7Z,10Z,13Z,16Z,19Z)/14:0), and Biliverdin-IX-α), a diagnostic model for BA was constructed using logistic regression analysis. The resulting ROC area under the curve was determined to be 0.968. This study presents an innovative and pioneering approach that utilizes metabolomics analysis to develop a diagnostic model for BA, thereby reducing the need for unnecessary invasive examinations and contributing to advancements in diagnosis and prognosis for patients with BA.

Hepatic Sinusoidal Obstruction Syndrome (SOS) represents a rare but serious adverse drug reaction. This study aimed to identify the medications most frequently associated with SOS risk through the analysis of the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database. We queried the FAERS database using OpenVigil 2.1 to search for all reported cases of SOS from 2004Q1 to 2022Q3. The 50 most frequently reported medications were ranked based on reported odds ratio (ROR) and proportional reporting ratio (PRR) values. We also compared these drugs with those reported in the LiverTox® database to assess consistency in hepatotoxicity reporting. A total of 1,976 SOS reports were indentified within the selected study period. Oxaliplatin was the most frequently reported medication associated with SOS, whereas the drug exhibited the strongest association with SOS death was busulfan. Disproportionality analysis revealed that the top five medications with the greatest association with SOS were tioguanine, inotuzumab ozogamicin, gemtuzumab ozogamicin, busulfan, and dactinomycin. Approximately half of the top 50 drugs (28 based on ROR and 27 based on PRR) were not outlined in LiverTox®. Our study offers a potential list of drugs commonly associated with SOS and identified several novel drugs associated with SOS that had not been previously described in LiverTox®. Not applicable.