M Madadi-Sanjani et al. JPGN Reports 2024: https://doi.org/10.1002/jpr3.12071. Open Access! Retrospective analysis of the standardized BARD criteria for acute cholangitis in biliary atresia patients

This retrospective study examined the Biliary atresia and Related Diseases (BARD) criteria for diagnosis of acute cholangitis in BA patients within the first year following Kasai hepatoportoenterostomy (HPE).

Key findings:

• Of 185 consecutive BA patients, 59 (32%) had at least one episode of cholangitis within the first year after HPE
• The correlation between the clinician’s impression and the standardized BARD definition was very strong (r = 0.8)
• Only 41% of patients believed by their physicians to have cholangitis had fever
• 70% had increased WBC and/or CRP, and/or procalcitonin
• 90% had increased bilirubin/GGT, 68% had increased transaminases
• Only one (1/59) patient in their cohort had a positive blood culture and only one (1/59) patient had bile lakes identified
• 56/59 children (94.9%), at least one laboratory or radiological item (group B) was pathologic at cholangitis diagnosis

My take: There really is not a precise way to diagnose cholangitis following HPE. Given how infrequently they are identified, it looks like both blood culture and bile lakes are not useful in establishing the diagnosis given. Overall, these criteria correlate well with how clinicians establish the diagnosis of cholangitis in at-risk children.

Related blog posts:

• Cholangitis After Kasai Procedure for Biliary Atresia
• Useful Data on Cholangitis Following Kasai Portoenterostomy
• “What Makes A “Successful” Kasai Portoenterostomy “Unsuccessful”?
• Customized Postoperative Therapy for Biliary Atresia -Does It Help?
• Prognostic Tool for Biliary Atresia after Kasai: Serum Bile Acids