Diagnostic performance of serum MMP-7 in biliary atresia: a systematic review and meta-analysis

Objective: Serum matrix metalloproteinase-7 (MMP-7) has been increasingly utilized in the detection of biliary atresia (BA). However, its diagnostic efficacy remains controversial. This study aims to clarify the value of MMP-7 in diagnosing BA. Materials and methods: A systematic search of PubMed, Web of Science, Embase, Cochrane Library, and Scopus from database inception to 1 September 2025 was performed. Main outcomes were sensitivity, specificity, diagnostic odds ratio (DOR), and mean area under the summary receiver operating characteristic curve (AUC). I 2 was used to evaluated heterogeneity, meanwhile meta-regression and subgroup analyses were adopted to investigated the source of heterogeneity. Results: Seventeen studies with 2784 patients with BA were included. The pooled sensitivity, specificity, DOR, and AUC were 0.93 (95% CI, 0.91-0.95), 0.90 (95% CI, 0.86-0.93), 123.77 (95% CI, 75.45-203.02) and 0.97 (95% CI, 0.95-0.98) respectively. Meta-regression showed that study type, study area, sample size, detection method and age were the main sources of heterogeneity (P < .05). Subgroup analyses showed higher pooled DOR in cohorts of infants < 60 days vs. unrestricted age (183.32 vs. 108.75), in prospective studies vs. retrospective study (348.74 vs. 101.58), and in Eastern vs. Western countries (149.83 vs. 51.15). Conclusion: The findings indicated that MMP-7 maintained outstanding diagnostic accuracy for BA and should be recommended as primary routine diagnostic strategy for patients with BA, particularly for infants under two months of age.