BACKGROUND: Severe acute cholangitis is a life-threatening biliary infection, leading to organ dysfunction, septic shock, and naturally death. Mortality has dropped significantly in the past years through improving resuscitation and biliary drainage techniques. The aim of our study is to analyze our daily practice and the factors associated with mortality. METHODS: A retrospective study including severe acute cholangitis patients admitted to our unit from January 2009 to December 2018. Variables analyzed (univariate then multivariate analysis) were age, sex, history, origin, evolution time, bilirubin, etiology, organ dysfunction, qSOFA, SOFA, TOKYO, biliary drainage timing and technique, shock, antibiotherapy, and resuscitation. RESULTS: 140 patients were included in this study. Average age was 61. Sex ratio M/F was 0.59. Lithiasis etiology was dominant (69%). SOFA average score upon admission was 8. Ceftriaxone + metronidazole was the empirical antibiotic used in 87%. Average time to biliary drainage was 1.58 ± 0.89 days. Endoscopic unblocking was the technique used in 76%. Mean duration of ICU stay was 6 days. Mortality rate was 28%. Statistically significant factors for mortality (p < 0.05) were history of taking anticoagulant treatment, use of catecholamines and mechanical ventilation during ICU stay, and delay in consultation and administration of antibiotic therapy. CONCLUSIONS: Early recognition, antibiotics, resuscitation, and minimally invasive biliary drainage have improved patient outcomes although there is still progress to be made. Moreover, as multiple organ failure is often associated with mortality in severe acute cholangitis, predictive risk factors of organ failure should be more investigated.
BACKGROUND: Severe acute cholangitis is a life-threatening biliary infection, leading to organ dysfunction, septic shock, and naturally death. Mortality has dropped significantly in the past years through improving resuscitation and biliary drainage techniques. The aim of our study is to analyze our daily practice and the factors associated with mortality. METHODS: A retrospective study including severe acute cholangitis patients admitted to our unit from January 2009 to December 2018. Variables analyzed (univariate then multivariate analysis) were age, sex, history, origin, evolution time, bilirubin, etiology, organ dysfunction, qSOFA, SOFA, TOKYO, biliary drainage timing and technique, shock, antibiotherapy, and resuscitation. RESULTS: 140 patients were included in this study. Average age was 61. Sex ratio M/F was 0.59. Lithiasis etiology was dominant (69%). SOFA average score upon admission was 8. Ceftriaxone + metronidazole was the empirical antibiotic used in 87%. Average time to biliary drainage was 1.58 ± 0.89 days. Endoscopic unblocking was the technique used in 76%. Mean duration of ICU stay was 6 days. Mortality rate was 28%. Statistically significant factors for mortality (p < 0.05) were history of taking anticoagulant treatment, use of catecholamines and mechanical ventilation during ICU stay, and delay in consultation and administration of antibiotic therapy. CONCLUSIONS: Early recognition, antibiotics, resuscitation, and minimally invasive biliary drainage have improved patient outcomes although there is still progress to be made. Moreover, as multiple organ failure is often associated with mortality in severe acute cholangitis, predictive risk factors of organ failure should be more investigated.
Authors: I A Meynaar; A H M Knook; S Coolen; H Le; M M E M Bos; F van der Dijs; M von Lindern; E W Steyerberg Journal: Neth J Med Date: 2013-11 Impact factor: 1.422
Authors: Y Tagashira; N Sakamoto; T Isogai; M Hikone; A Kosaka; R Chino; M Higuchi; Y Uehara; H Honda Journal: Clin Microbiol Infect Date: 2017-02-28 Impact factor: 8.067
Authors: Paul D James; Gilaad G Kaplan; Robert P Myers; James Hubbard; Abdel Aziz Shaheen; Jill Tinmouth; Elaine Yong; Jonathan Love; Steven J Heitman Journal: Clin Gastroenterol Hepatol Date: 2013-10-02 Impact factor: 11.382
Authors: Ban Seok Lee; Jin-Hyeok Hwang; Sang Hyub Lee; Sang Eon Jang; Eun Sun Jang; Hyun Jin Jo; Cheol Min Shin; Young Soo Park; Jin-Wook Kim; Sook-Hyang Jung; Nayoung Kim; Dong Ho Lee; Jun Kyu Lee; Soyeon Ahn Journal: Dig Dis Sci Date: 2012-11-22 Impact factor: 3.199