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Acute Pancreatitis II: Clinical Manifestations and Management01:30

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Related Experiment Video

Updated: Jan 18, 2026

Colon Ascendens Stent Peritonitis CASP - a Standardized Model for Polymicrobial Abdominal Sepsis
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Screening acute cholangitis patients for sepsis.

Andrei M Beliaev1, Sof'ya Zyul'korneeva2, David Rowbotham3

  • 1Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand.

ANZ Journal of Surgery
|October 1, 2019
PubMed
Summary

The Systemic Inflammatory Response Syndrome (SIRS) test is more effective than the 2018 Tokyo Guidelines (TG18) for screening acute cholangitis (AC) patients for sepsis. However, the SIRS test shows a low positive predictive value for sepsis in AC.

Keywords:
acute cholangitisscreeningsepsissystemic inflammatory response syndrome

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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Acute cholangitis (AC) with septic shock has a high mortality rate (40%).
  • Effective screening for sepsis in AC patients remains a challenge.
  • Early sepsis detection is crucial for improving patient outcomes.

Purpose of the Study:

  • To compare the diagnostic accuracy of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the 2018 Tokyo Guidelines (TG18) for sepsis screening in AC patients.
  • To evaluate the predictive abilities of both the SIRS and TG18 tests.
  • To identify the optimal screening method for sepsis in the context of AC.

Main Methods:

  • A retrospective diagnostic accuracy study was conducted.
  • The SIRS and TG18 tests were applied to patients with AC.
  • Patients were categorized based on shock index and presence of complications like choledocholithiasis.

Main Results:

  • The SIRS test demonstrated higher sensitivity (93%) and specificity (79%) compared to the TG18 test (69% sensitivity, 68% specificity).
  • The SIRS test showed a significantly larger area under the receiver operating characteristic curve (86% vs. 69%, P = 0.0004).
  • While the SIRS test had a high negative predictive value (97%), its positive predictive value was low (57%).

Conclusions:

  • The SIRS test exhibits superior discriminative power for identifying sepsis in AC patients compared to TG18 criteria.
  • Despite its high sensitivity, the low positive predictive value of the SIRS test warrants cautious interpretation.
  • Further research may be needed to refine sepsis screening protocols for AC.