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"Kejadian kolangitis pasca prosedur Kasai (PK) terbukti berhubungan dengan prognosis buruk, dan dilakukannya transplantasi hati dini pada Atresia Bilier (AB). Untuk menyelidiki faktor risiko yang memengaruhi kejadian kolangitis, telah dilakukan penelitian retrospektif pasien AB pasca PK. Suatu penelitian kohort retrospektif, pada anak AB pasca PK yang menjalani perawatan di RSCM. Subjek direkrut dengan metode consecutive sampling pada semua anak usia 0– 18 tahun dengan AB pasca PK sejak Januari 2020 hingga Desember 2023. Beberapa faktor risiko preoperatif pada anak AB yang menjalani PK di antaranya usia saat PK ≥60 hari, infeksi Cytomegalovirus (CMV); kadar gamma-glutamyl transpeptidase (GGT), kadar bilirubin direk, dan kadar alanine aminotransferase (ALT); serta derajat berat fibrosis hati, dan malnutrisi sebelum PK. Faktor-faktor tersebut dikumpulkan dan dianalisis untuk menentukan faktor risiko yang memengaruhi terjadinya kolangitis. Rekam medis yang lengkap dari 82 pasien dievaluasi secara retrospektif. Subjek penelitian sebagian besar perempuan, usia saat menjalani PK berkisar 76 – 90 hari, gizi kurang, dan derajat fibrosis hati F4. Prevalensi kolangitis yang ditemukan 69.5%. Faktor risiko preoperatif kadar ALT dan GGT yang lebih buruk, serta malnutrisi tidak terbukti memengaruhi terjadinya kolangitis pasca PK pada analisis multivariat regresi logistik. Faktor risiko preoperatif kadar ALT dan GGT yang lebih buruk, serta malnutrisi pada anak AB pasca PK tidak terbukti memengaruhi terjadinya kolangitis. Namun kondisi malnutrisi pada pasien sebelum PK cenderung menjadi faktor yang berhubungan dengan kejadian kolangitis pasca PK.

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The occurrence of cholangitis after the Kasai procedure (KP) is linked with a poor prognosis and early liver transplantation in Biliary Atresia (BA). To investigate the risk factors influencing the occurrence of cholangitis, we conducted a retrospective study on BA patients after KP. A retrospective cohort study was conducted on post-KP BA children undergoing treatment at RSCM. Subjects were selected using a consecutive sampling method among all children aged 0–18 years with post-KP BA from January 2020 to December 2023. Several preoperative risk factors in AB children undergoing KP, including age at KP≥60 days, Cytomegalovirus (CMV) infection, gamma-glutamyl transpeptidase (GGT), direct bilirubin, and alanine aminotransferase (ALT), as well as the severity of liver fibrosis and malnutrition before KP, were collected and analyzed to determine the risk factors influencing the occurrence of cholangitis. The complete medical records of 82 patients were evaluated retrospectively. The majority of the research subjects were female. The age at which the KP was carried out ranged from 76 – 90 days, and there were indications of poor nutrition and liver fibrosis at level F4. The prevalence of cholangitis was found to be 69.5%. Preoperative risk factors for worse ALT and GGT levels, as well as malnutrition, were not shown to influence the occurrence of cholangitis after KP in multivariate logistic regression analysis. Although preoperative risk factors for worse ALT and GGT levels, as well as malnutrition in BA children after KP, were not proven to influence the occurrence of cholangitis, malnutrition in patients before KP seems to be associated with the incidence of cholangitis after KP."

"Latar belakang: Pemanfaatan modalitas diagnostik terbaru dalam diagnosis dan penatalaksanaan pasien dengan kolangitis akut telah berkontribusi pada penurunan mortalitas yang signifikan. Salah satu modalitas diagnosis kolangitis akut yang dewasa ini banyak digunakan secara luas adalah menggunakan kriteria diagnosis Tokyo. Walaupun demikian, kriteria TG18 masih memiliki spesifisitas yang relatif kurang, sehingga menyebabkan masih cukup tingginya temuan diagnosis positif palsu. Oleh karena itu, diperlukan penanda inflamasi yang lebih spesifik terhadap infeksi, misalnya procalcitonin (PCT), yang diharapkan dapat meningkatkan spesifisitas diagnosis kriteria TG18. Tujuan penelitian ini adalah menentukan akurasi diagnostik dan nilai tambah pemeriksaan kadar prokalsitonin dalam diagnosis kolangitis akut. Metode: Penelitian observasional prospektif dengan desain potong lintang ini dilakukan di Unit Gawat Darurat, rawat jalan, dan Pusat Endoskopi Saluran Cerna (PESC) RSUPN Cipto Mangunkusumo pada bulan April sampai Desember 2022. Penelitian ini melibatkan 84 pasien ikterus obstruktif yang direncanakan untuk tindakan drainase bilier di RSUPN Cipto Mangunkusumo. Kriteria yang digunakan adalah kriteria TG18. Pemeriksaan baku emas dikatakan positif apabila ditemukan salah satu bukti dari pemeriksaan baku emas, yaitu drainase bilier purulen secara makroskopik pada drainase yang pertama dan kultur bilier positif. Hasil: Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif dan rasio kemungkinan positif dari kriteria diagnostik Tokyo 2018 dalam diagnosis kolangitis akut berturut-turut sebesar 97,10%; 0,0%; 81,71%; 0,0%; dan 0,97.Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif dan rasio kemungkinan positif, dan rasio kemungkinan negatif dari kriteria diagnostik prokalsitonin dalam diagnosis kolangitis akut berturut-turut sebesar 69,6%; 80,0%; 94,12%; 36,36%; 3,48; dan 0,38. Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif dan rasio kemungkinan positif, dan rasio kemungkinan negatif dari kombinasi prokalsitonin dan kriteria TG18 dalam diagnosis kolangitis akut berturut-turut sebesar 69,6%; 80,0%; 94,12%; 36,36%; 3,48; dan 0,38 Kesimpulan: Kriteria TG18 dengan parameter prokalsitonin tidak terbukti dapat meningkatkan nilai diagnostik dari parameter prokalsitonin secara tunggal dalam mendeteksi kolangitis akut.

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Background: Utilization of the latest diagnostic modalities in the diagnosis and management of patients with acute cholangitis has contributed to a significant reduction in mortality. One of the modalities for the diagnosis of acute cholangitis which is widely used today is the Tokyo diagnostic criteria. Even so, the TG18 criteria still have relatively low specificity, resulting in a relatively high number of false positive diagnosis findings. Therefore, a marker of inflammation that is more specific to infection is needed, for example procalcitonin (PCT), which is expected to increase the specificity of the diagnosis of the TG18 criteria. The purpose of this study was to determine the diagnostic accuracy and added value of testing procalcitonin levels in the diagnosis of acute cholangitis. Methods: This prospective observational study with a cross-sectional design was conducted at the Emergency Unit, outpatient care, and PESC of Cipto Mangunkusumo General Hospital from April to December 2022. This study involved 84 patients with obstructive jaundice who were planned for biliary drainage at Cipto Mangunkusumo General Hospital. The criteria used are the TG18 criteria. The gold standard examination is proven positive if one of the following criteria was noted: namely macroscopic purulent biliary drainage in the first drainage and positive biliary culture.

Results: Sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio of TG18 criteria in detecting acute cholangitis were 97,10%; 0,0%; 81,71%; 0,0%; and 0,97, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of procalcitonin in detecting acute cholangitis were 69,6%; 80,0%; 94,12%; 36,36%; 3,48; and 0,38, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of combined procalcitonin and TG18 criteria in the diagnosis of acute cholangitis were 69,6%; 80,0%; 94,12%; 36,36%; 3,48; and 0,38, respectively. Conclusion: TG18 criteria combined with procalcitonin was not found to be superior to procalcitonin only in the diagnosis of acute cholangitis."