Predictive Value of Risk Factors in Patients with Obstructive Jaundice

Pitiakoudis, Michail; Mimidis, Konstantinos; Tsaroucha, AK; Papadopoulos, Vassilios; Karayiannakis, Anastasios J.; Simopoulos, C.

doi:10.1177/147323000403200608

Cited by 18 publications

(18 citation statements)

References 14 publications

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“…sepsis, coagulopathy, hepatic coma and renal failure) have been reported in literature to be associated with high mortality rate in these patients (Hussain &Fatima, 2000;Pitiakoudis et al, 2004;Uslu et al, 2007;Moghimi et al, 2008;Chalya et al, 2011). Our mortality rate of 20.3% was higher that reported by others (Moghimi et al;Chalya et al, 2011).…”

Section: Discussioncontrasting

confidence: 54%

“…The mortality and morbidity of biliary obstruction are dependent on the cause of the obstruction, and the assessment of any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society is necessary (Moghimi et al, 2008;Pitiakoudis et al, 2004). Understanding factors responsible for increased morbidity and mortality in these patients will better guide appropriate management and lead to improved survival (Buckwate, 1965).…”

Section: Introductionmentioning

confidence: 99%

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Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Mabula

Gilyoma

Mchembe

et al. 2014

Tanzania J Hlth Res

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Despite recent advances both in preoperative diagnosis and postoperative care, obstructive jaundice still contributes significantly to high morbidity and mortality. A prospective study was undertaken to identify predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania. A total of 138 patients were studied. The male to female ratio was 1:1.6. The median age of patients was 58 years. Patients with malignant obstructive jaundice were older than those of benign type (P < 0.001). Ca head of pancreas (65.1%) was the commonest malignant cause of jaundice where as choledocholithiasis (51.9%) was the commonest benign cause. Twelve (9.7%) patients were HIV positive with a median CD 4+ count of 342 cells/l. A total of 130 (94.2%) patients underwent surgical treatment and the remaining 8 (5.8%) patients were unfit for surgery. The complication rate was 30.4% mainly due to surgical site infections and it was significantly influenced by malignant causes, WBC count > 10 X 109/l and HIV infection with low CD4 ( 200 cells/l) (p < 0.0001). The median hospital stay and mortality rate were 18 days and 20.3%, respectively. A low haematocrit and presence of postoperative complications were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes, high bilirubin levels, HIV infection with low CD4+ count ( 200 cells/l) and presence of postoperative complications significantly predicted mortality (P< 0.001). In conclusion, our study highlighted the important factors that predict the outcome of patients presenting with obstructive jaundice at BMC; therefore attention should be focused to these factors so as to improve the outcome of these patients.

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Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Mabula

Gilyoma

Mchembe

et al. 2014

Tanzania J Hlth Res

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“…The mortality and morbidity of biliary obstruction are dependent on the cause of the obstruction, and the assessment of any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society is necessary [6,15]. It has been reported that obstructive jaundice continues to be associated with significant morbidity and mortality despite recent advances both in preoperative diagnosis and postoperative care [15-17]. Understanding factors responsible for increased morbidity and mortality in these patients will better guide appropriate management and lead to improved survival [17].…”

Section: Introductionmentioning

confidence: 99%

Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

2011

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BackgroundObstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality.MethodsThis was a descriptive prospective study which was conducted at Bugando Medical Centre between July 2006 and June 2010. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS computer software version 11.5.ResultsA total of 116 patients were studied. Females outnumbered males by a ratio of 1.3:1. Patients with malignant obstructive jaundice were older than those of benign type. Ca head of pancreas was the commonest malignant cause of jaundice where as choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the only diagnostic imaging done in all patients and revealed dilated intra and extra-hepatic ducts, common bile stones and abdominal masses in 56.2%, 78.9%, 58.1% and 72.4% of the cases respectively. A total of 110 (94.8%) patients underwent surgical treatment and the remaining 6 (5.2%) patients were unfit for surgery. The complication rate was 22.4% mainly surgical site infections. The mean hospital stay and mortality rate were 14.54 days and 15.5% respectively. A low haematocrit and presence of postoperative sepsis were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes and presence of postoperative complications mainly sepsis significantly predicted mortality (P < 0.001).ConclusionObstructive jaundice in our setting is more prevalent in females and the cause is mostly malignant. The result of this study suggests that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive jaundice.

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“…Delay in presentation and treatment can lead to significant morbidity and mortality due to secondary infections causing cholangitis, liver abscess and systemic effect like malnutrition, weight loss, decreased immunity and renal insufficiency. [16] In our study too, benign causes were commoner, but post cholecystectomy biliary stricture was commonest as opposed to stone disease, seen in only one. In a study of 116 patients by Chalya et al, [14] higher number of patients (58.6%) had association with malignant etiology but choledocholithiasis was the commonest (62.5%) cause among benign (62.5%) and carcinoma of the head of pancreas (64.7%) among the malignant causes similar to our study.…”

Section: Discussionmentioning

confidence: 93%

Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

Chaturvedi¹,

Chaudhari²,

Kekan³

et al. 2017

APALM

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Background: Biliary obstruction can present with distressing symptoms and increased morbidity which leads to liver fibrosis, cholestasis, portal inflammation and ductular proliferation. Experimental studies showed reversal of histological findings in liver after biliary decompression surgery; however only a limited data is available regarding the same. Methods:Prospective observational study of 28 liver biopsies from 14 patients of obstructive jaundice, who underwent decompression surgery and showed clinical deterioration at 6 weeks with normal HIDA scan. Patients were clinically evaluated. Both intra (1st bx) and postoperative (2nd bx) liver biopsies were studied for fibrosis, cholestasis, ductular proliferation and portal inflammation.Result: Patient's age ranged from 24 to 75 years (8 Males and females 6), commonest symptom being jaundice. In 1st bx, most of the patients showed histological evidence of obstruction, which improved at least partially after surgery. There was no definite correlation of fibrosis with etiology. Fibrosis was less commonly seen with shorter duration of symptoms and younger males had higher prevalence. Increase/ static grades of fibrosis were seen in 35.71% patients each, while 28.57% showed regression. No correlation of age and etiology with status of fibrosis was observed. Regression was more common in males and with absence of cholangitis while progression was more common in females and with presence of cholangitis. Conclusion:We wonder whether younger males are more prone for fibrosis but males in general have better prognosis regarding the reversal. Also, cholangitis could be an important factor for deciding the further course of fibrosis. However we require larger data with multivariate analysis for the confirmation of the same.

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Predictive Value of Risk Factors in Patients with Obstructive Jaundice

Cited by 18 publications

References 14 publications

Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

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