Related Experiment Video
Updated: May 7, 2026
Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System
Published on: October 16, 2013
Development and internal validation of a risk stratification scoring system for identifying gram-negative
Phoomjai Sornsenee1, Chanchanok Chaochuensuk2, Duangkiat Sapsong2
1Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Background:
Acute cholangitis, a severe biliary infection that is frequently caused by gram-negative pathogens, presents health challenges owing to the increasing prevalence of antimicrobial resistance, particularly among extended-spectrum beta-lactamase (ESBL)-producing bacteria. Accurate risk stratification of patients with extended-spectrum beta-lactamase-producing bacteria is crucial for optimizing antimicrobial therapies.
Aims:
This study aimed to develop and internally validate a risk stratification scoring system for identifying ESBL-producing bacteria in patients with acute cholangitis, with the goal of supporting clinical risk stratification.
Methods:
This retrospective cohort analysis included adult patients with acute cholangitis admitted between 2019 and 2023. Patients were excluded if they had incomplete medical records, missing microbiological data, or non-adherence to the Tokyo Guidelines 2018 diagnostic criteria. Predictors of positivity for ESBL-producing bacteria were identified using multivariate logistic regression and integrated into a scoring system, and the performance metrics were evaluated.
Results:
A total of 303 patients with positive blood or bile cultures were included in the analysis, of whom 111 (36.6%) had ESBL-positive cholangitis. Independent predictors of positivity for ESBL-producing bacteria included prior antibiotic treatment (3.5 points), chills with rigors (2.5 points), alanine aminotransferase levels <400 U/L (3.5 points), hematocrit levels <27% (2.5 points), and alkaline phosphatase levels >300 U/L (2.0 point). At cutoff scores of 7.5 and 11, the scoring system demonstrated sensitivity of 56% and 16%, specificity of 75% and 98%, positive predictive values of 56% and 82%, and overall accuracy of 68% and 70%, respectively.
Conclusions:
This preliminary scoring system demonstrated high specificity at higher cutoffs, supporting its use as a rule-in tool for identifying patients at high risk of ESBL-producing bacteria in acute cholangitis. However, its moderate sensitivity limits its role as a rule-out strategy. This preliminary internally validated model should not be used to guide routine clinical decision-making without external multicenter validation, and any application must consider local resistance patterns and patient context.
