Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis

Abstract

BACKGROUND Acute cholangitis (AC) is a disease spectrum with varying extent of severity. Age ≥ 75 years forms part of the criteria for moderate (Grade II) severity in both the Tokyo Guidelines (TG13 and TG18). Aging is associated with reduced physiological reserves, frailty, and sarcopenia. However, there is evidence that age itself is not the determinant of inferior outcomes in elective and emergency biliary diseases. There is a paucity of reports comparing clinical outcomes amongst elderly patients vs non-elderly patients with AC. AIM To investigate the effect of age (≥ 80 years) on AC's morbidity and mortality using propensity score matching (PSM). METHODS This is a single-center retrospective cohort study of all patients diagnosed with calculous AC (January 2016 to December 2016) and ≥ 80 years old (January 2012 to December 2016) at a tertiary university-affiliated teaching hospital. Inclusion criteria were patients who were treated for suspected or confirmed AC secondary to biliary stones. Patients with AC on a background of hepatobiliary malignancy, indwelling permanent metallic biliary stents, or concomitant pancreatitis were excluded. Elderly patients were defined as ≥ 80 years old in our study. A 1:1 PSM analysis was performed to reduce selection bias and address confounding factors. Study variables include comorbidities, vital parameters, laboratory and radiological investigations, and type of biliary decompression, including the time for endoscopic retrograde cholangiopancreatography (ERCP). Primary outcomes include in-hospital mortality, 30-d and 90-d mortality. Length of hospital stay (LOS) was the secondary outcome. RESULTS Four hundred fifty-seven patients with AC were included in this study (318 elderly, 139 non-elderly). PSM analysis resulted in a total of 224 patients (112 elderly, 112 non-elderly). The adoption of ERCP between elderly and non-elderly was similar in both the unmatched (elderly 64.8%, non-elderly 61.9%, P = 0.551) and matched cohorts (elderly 68.8% and non-elderly 58%, P = 0.096). The overall in-hospital mortality, 30-d mortality and 90-d mortality was 4.6%, 7.4% and 8.5% respectively, with no statistically significant differences between the elderly and non-elderly in both the unmatched and matched cohorts. LOS was longer in the unmatched cohort [elderly 8 d, interquartile range (IQR) 6-13, vs non-elderly 8 d, IQR 5-11, P = 0.040], but was comparable in the matched cohort (elderly 7.5 d, IQR 5-11, vs non-elderly 8 d, IQR 5-11, P = 0.982). Subgroup analysis of patients who underwent ERCP demonstrated the majority of the patients ( n = 159/292, 54.5%) had delayed ERCP (> 72 h from presentation). There was no significant difference in LOS, 30-d mortality, 90-d mortal...

Primary endoscopic bile duct stone removal for severe acute cholangitis: a retrospective study

“…Singapore’s propensity score–matched analysis reported an overall in-hospital mortality rate of 4.6%, a 30-day mortality rate of 7.4%, and a 90-day mortality rate of 8.5%. 9 The mortality rate of SAC using the currently revised TG13/18 severity assessment was 5.1% in a joint study between Japan and Taiwan. There is no dispute that the mortality rate of SAC is high; 10 however, problems with the diagnostic criteria for SAC have also been highlighted.…”

Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality in patients over 80 years old

“…Inferior clinical outcomes in the elderly could be attributed to increased medical co-morbidity, malnutrition, frailty, diminished physiologic reserves, immunosenescence, altered pharmacokinetics and pharmacodynamics, polypharmacy, and institutionalization [ 20 - 22 ]. Though the World Health Organization has defined young elderly (aged 65-85 years) and old elderly (over 85 years), many authors continue to use the age cut-offs of 70 years, 75 years, and 80 years to study the impact of age [ 6 , 12 , 23 ]. The TG has made efforts to standardize diagnostic and severity stratification criteria, and the system is regularly reviewed and updated.…”

“…In a propensity-score matched study including 224 patients AC patients (112 patients ≥ 80 years, 112 patients < 80 years age), Chan et al . reported no statistically significant differences in overall in-hospital mortality, 30-day mortality, and 90-day mortality between the elderly and non-elderly in both the unmatched and matched cohorts [ 12 ]. Thus, it is likely that mortality risk is not solely determined by age.…”

“…Thus, it remains to be shown that improved diagnostic accuracy and risk stratification by TG18 contribute to good outcomes. There is emerging evidence that mortality does not differ between the elderly (≥ 80 years old) and non-elderly patients (< 80 years old) with AC [ 12 ]. This study aims to identify the mortality predictors in patients over 80 years of age.…”

Aging is Associated with Prolonged Hospitalisation Stay in Pyogenic Liver Abscess—A 1:1 Propensity Score Matched Study in Elderly Versus Non-Elderly Patients

“…However, another study by Law and Li ( 19 ) on 319 patients (age ≥ 65 years old [52.7%]) showed that age ≥ 65 years old is associated with a higher mortality rate. Furthermore, old age is associated with the confounding effect of co-morbidity, which may worsen outcomes ( 20 ). However, there is a paucity of literature on the real impact of age on outcomes in PLA.…”