Risk Factors for Death of Elderly Patients with Acute Obstructive Suppurative Cholangitis

Obi, C L; Wang, L P; Qiao, S; Wang, X F; Zhang, X; Sun, Rui; Liu, J G; Li, Y C

doi:10.7727/wimj.2014.345

Cited by 5 publications

(9 citation statements)

References 18 publications

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“…Severe acute cholangitis and AOSC easily result in sepsis[17,18]; the elderly population is a target of AOSC[42,44]. Emergent biliary drainage is critical for patients with life-threatening conditions[19].…”

Section: Discussionmentioning

confidence: 99%

“…AOSC commonly occurs in elderly patients[42,44]; emergent biliary drainage is required in these patients[19]. Interventional endoscopists may choose endoscopic sphincterotomy (EST).…”

Section: Acute Obstructive Suppurative Cholangitismentioning

confidence: 99%

“…Laparoscopic choledocholithotomy is considered a safe and feasible therapeutic option[22,26-28,31]. As described above, AOSC frequently occurs in elderly patients[42,44]; laparoscopic surgery should be chosen even in this population.…”

Section: Acute Cholangitis and Bile Duct Stonesmentioning

confidence: 99%

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Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation

Hori

2019

WJG

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Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy ( i.e ., choledocholithotomy) or diversion ( i.e ., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes; however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.

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Section: Discussionmentioning

confidence: 99%

“…AOSC commonly occurs in elderly patients[42,44]; emergent biliary drainage is required in these patients[19]. Interventional endoscopists may choose endoscopic sphincterotomy (EST).…”

Section: Acute Obstructive Suppurative Cholangitismentioning

confidence: 99%

See 1 more Smart Citation

Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation

Hori

2019

WJG

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“…The study de ned respiratory failure as oxygenation index < 200 mmHg, circulatory failure or shock as requiring vasopressors to maintain a mean arterial blood pressure above 65 mmHg, and bacteremia as blood cultures identifying the presence of bacteria. Thrombocytopenia was de ned as platelet count < 100×10 9 /L and severe thrombocytopenia de ned as platelet count < 50×10 9 /L.…”

Section: Clinical Data Collection and Laboratory Examinationmentioning

confidence: 99%

“…Thrombocytopenia frequently occurs in severe infections due to the consumption of platelet and the reduction of clotting factors. About 40% of severe sepsis patients have platelet count < 80×10 9 /L and about 50% of patients in intensive care units (ICU) have thrombocytopenia [5]. Platelets are critical key players in sepsis and MODS caused by sepsis [4,6].…”

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confidence: 99%

Use of platelet count on admission for determining illness severity and predicting prognosis in acute cholangitis patients

Chen

Hou

Zhang

et al. 2023

Preprint

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Background Thrombocytopenia often occurs in patients with acute cholangitis and is a risk factor for poor prognosis in acute cholangitis. The study was to investigate the relationship between platelet count and illness severity and their performances in predicting hospital mortality. Methods This was a single-center, retrospective, observational cohort study. We analyzed 498 patients with acute cholangitis who were admitted to our hospital between July 2013 and July 2021. The correlation between admission platelet count and severity and prognosis of patients was analyzed. Results 1) In this study, the incidence of acute cholangitis thrombocytopenia (platelet count < 100×109/L) and severe thrombocytopenia (platelet count < 50×109/L) were 31.12% and 7.43%, respectively. 2) Platelet count of the Thrombocytopenia group was 64(42, 79) × 109/L. Compared with the NO-Thrombocytopenia group, the Thrombocytopenia group had more Grade III patients, higher complication rates (respiratory failure, circulatory failure, bacteremia), and higher APACHE II score and SOFA score (P < 0.05). 3) The 60-day mortality rate was significantly higher in the Thrombocytopenia group than that in the NO-Thrombocytopenia group (12.90% vs. 2.33%, P < 0.001). Binary logistic regression analysis demonstrated that platelet count at hospital admission was a risk factor for death. 4) ROC curve analysis showed that platelet count cut-off value for predicting the death of patients with acute cholangitis was 84×109/L, with sensitivity of 0.764, specificity of 0.714, and an AUC of 0.760. Conclusions Platelet count is a readily available, prognostic marker that can identify acute cholangitis patients with poorer outcome.

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Characteristics and clinical outcomes of acute cholangitis in older patients

et al. 2023

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Risk Factors for Death of Elderly Patients with Acute Obstructive Suppurative Cholangitis

Abstract: The strategies of dealing with these risk factors should be researched to reduce mortality of elderly patients with AOSC.

Cited by 5 publications

References 18 publications

Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation

Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation

Use of platelet count on admission for determining illness severity and predicting prognosis in acute cholangitis patients

Characteristics and clinical outcomes of acute cholangitis in older patients

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