Early biliary drainage is associated with favourable outcomes in critically-ill patients with acute cholangitis

Aboelsoud, Mohammed M.; Siddique, Osama; Morales, Alexander; Seol, Young-Jun; Al-Qadi, Mazen O.

doi:10.5114/pg.2018.74557

Cited by 21 publications

(24 citation statements)

References 17 publications

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“…But it has decreased to 10-30% since 1980, with the development of endoscopic biliary drainage techniques and the various associated therapeutic modalities [ 1 , 7 , 8 ]. Current mortality rates vary between 9.6% and 37% [ 6 , 9 – 11 ], and death is most often due to a multiorgan failure related to a refractory septic shock [ 1 ]. This is consistent with our results which showed a mortality rate of 28% and refractory septic shock as the leading cause of death.…”

Section: Discussionmentioning

confidence: 99%

“…Procalcitonin has been proposed by some authors as a predictive indicator of severity and therefore of urgent biliary decompression [ 20 ], but this needs to be validated by more well-designed studies. According to previous studies, biliary drainage is the most important factors associated with mortality [ 9 – 11 ]. Time to biliary decompression did not stand out as a prognosis factor in our series.…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated with Mortality in Severe Acute Cholangitis in a Moroccan Intensive Care Unit: A Retrospective Analysis of 140 Cases

Touzani

Bouazzaoui

Bouyarmane

et al. 2021

Gastroenterology Research and Practice

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Associated with Mortality in Severe Acute Cholangitis in a Moroccan Intensive Care Unit: A Retrospective Analysis of 140 Cases

Touzani

Bouazzaoui

Bouyarmane

et al. 2021

Gastroenterology Research and Practice

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“…A recent single center study from Denmark found that ERCP within 24 h was associated with lower 30-d mortality (OR 0.23, 95%CI: 0.05-0.95)[4]. Several similar retrospective studies did not find a difference in mortality between early and late ERCP[6-9]. This could be related to the low statistical power of some of these studies, and the low incidence of mortality in some cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…Several small, single center retrospective studies found that early ERCP (within 24 to 72 h of admission) is associated with lower in hospital and 30-d mortality, compared to late ERCP[2-5]. Other studies did not show a difference in mortality between early and late ERCP[6-9]. The association of early ERCP with outcomes could vary in patients depending on their disease severity.…”

Section: Introductionmentioning

confidence: 99%

Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis

Mulki¹,

Shah²,

Qayed³

2019

WJGE

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AIMTo assess the effect of early vs late endoscopic retrograde cholangiopancreatography (ERCP) on mortality and readmissions in acute cholangitis, using a nationally representative sample.METHODSWe used the 2014 National Readmissions Database to identify adult patients hospitalized with acute cholangitis who underwent therapeutic ERCP within one week of admission. Early ERCP was defined as ERCP performed on the same day of admission or the next day (days 0 or 1, < 48 h), and late ERCP was performed on days 2 to 7 of admission. Patients with severe cholangitis had any of the following additional diagnoses: Severe sepsis, septic shock, acute renal failure, acute respiratory failure, or thrombocytopenia. Multivariate logistic regression was used to calculate the adjusted odds of association of ERCP timing with in-hospital mortality, 30-d mortality, and 30-d readmissions, controlling for age, sex, severe disease and comorbidities.RESULTSFour thousand five hundred and seventy patients satisfied the inclusion criteria; with a mean age of 64.1 years. Of these, 66.6% had early ERCP, while 33.4% had late ERCP. Early ERCP was associated with lower in-hospital mortality [1.2% vs 2.4%, adjusted odds ratio (aOR) = 0.50, 95%CI: 0.76-0.83, P = 0.001] and lower 30-d mortality (1.5% vs 3.3%, aOR = 0.48, 95%CI: 0.33-0.69, P < 0.0001) compared to the late ERCP group. Similarly, early ERCP was associated with lower 30-d readmissions (9.7% vs 15.1%, aOR = 0.58, 95%CI: 0.49-0.7, P < 0.0001). When stratified by severity of cholangitis, there was a similar benefit of early ERCP on all outcomes in those with and without severe cholangitis. The mean length of stay was higher in the late ERCP group compared to the early ERCP group (6.9 d vs 4.5 d, P < 0.0001). The mean hospitalization cost was higher in the late ERCP group ($21459 vs $16939, P < 0.0001).CONCLUSIONEarly ERCP is associated with lower in-hospital and 30-d mortality in those with or without severe cholangitis. Regardless of severity, we suggest performing early ERCP.

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“…In addition, ERCP was efficient, considered as optimal in 70% of the case. Non-optimal procedure may be due to infiltrating tumor-related AC supporting that a non-gallstone biliary obstacle is an independent pejorative prognosis factor [ 13 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

Lavillegrand

Mercier-Des-Rochettes

Baron

et al. 2021

Crit Care

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Background Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Methods Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis. Results Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients (n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12–1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones (p < 0.05) and AC complications (OR 2.74 [95% CI 1.45–5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02). Conclusions In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.

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Early biliary drainage is associated with favourable outcomes in critically-ill patients with acute cholangitis

Cited by 21 publications

References 17 publications

Factors Associated with Mortality in Severe Acute Cholangitis in a Moroccan Intensive Care Unit: A Retrospective Analysis of 140 Cases

Factors Associated with Mortality in Severe Acute Cholangitis in a Moroccan Intensive Care Unit: A Retrospective Analysis of 140 Cases

Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis

Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

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