Cureus · 2025
Serum Procalcitonin as an Indicator of Disease Severity and Clinical Deterioration in Hospitalized Patients With Acute Cholangitis.
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Kozai Landon A, Nishimura Yoshito, Czech Torrey, Tan Arvin Jeremy N, Benavente Kevin, Silangruz Krixie, Fujii-Lau Larissa
Аннотация
BACKGROUND: Acute cholangitis (AC) results from bile stasis and subsequent infection in the biliary tract, requiring urgent evaluation to determine the timing of biliary decompression. Procalcitonin (PCT) and lactic acid (LAC) may be reliable indicators of disease severity to suggest early biliary decompression. We seek to assess the utility of PCT and LAC to predict severe AC and adverse in-hospital outcomes such as ICU transfer, vasopressor use, or mortality.
METHODS: This is a retrospective observational study of patients admitted with AC to a tertiary hospital in the United States between January 1, 2016, and December 31, 2020. Patients were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for AC. Patients who had both PCT and LAC measured upon presentation were included. Logistic regression analysis was performed to determine the diagnostic performance of PCT and LAC to predict the outcomes.
RESULTS: A total of 193 patients, accounting for 229 hospital encounters, were identified. Choledocholithiasis was the most common cause of biliary obstruction (31.9%), followed by mass or malignancy (21.0%). Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 40.2% of patients. Percutaneous transhepatic biliary drainage and conservative management occurred in 21.8% and 34.5% of patients, respectively. PCT was non-superior to LAC and had low predictive values for the prediction of in-hospital mortality, ICU admission, or need for early decompression. In a subgroup analysis of malignancy-related cholangitis, PCT was superior to LAC in predicting in-hospital mortality (area under the receiver operating characteristic curve (AUROC) 0.932), ICU admission (AUROC 0.730), and need for early decompression (AUROC 0.767).
CONCLUSIONS: The findings of this study do not support the routine use of PCT in the evaluation of non-malignancy-related AC. PCT may be useful as a predictor of poor in-hospital outcomes in patients with malignancy-related AC. Further research is required to clarify its role in the evaluation of patients with AC.
METHODS: This is a retrospective observational study of patients admitted with AC to a tertiary hospital in the United States between January 1, 2016, and December 31, 2020. Patients were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for AC. Patients who had both PCT and LAC measured upon presentation were included. Logistic regression analysis was performed to determine the diagnostic performance of PCT and LAC to predict the outcomes.
RESULTS: A total of 193 patients, accounting for 229 hospital encounters, were identified. Choledocholithiasis was the most common cause of biliary obstruction (31.9%), followed by mass or malignancy (21.0%). Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 40.2% of patients. Percutaneous transhepatic biliary drainage and conservative management occurred in 21.8% and 34.5% of patients, respectively. PCT was non-superior to LAC and had low predictive values for the prediction of in-hospital mortality, ICU admission, or need for early decompression. In a subgroup analysis of malignancy-related cholangitis, PCT was superior to LAC in predicting in-hospital mortality (area under the receiver operating characteristic curve (AUROC) 0.932), ICU admission (AUROC 0.730), and need for early decompression (AUROC 0.767).
CONCLUSIONS: The findings of this study do not support the routine use of PCT in the evaluation of non-malignancy-related AC. PCT may be useful as a predictor of poor in-hospital outcomes in patients with malignancy-related AC. Further research is required to clarify its role in the evaluation of patients with AC.