Hepatobiliary & pancreatic diseases international : HBPD INT · 2025
Early prediction of mortality in acute cholangitis: Elaboration of a new simple prognostic score.
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Hocine Karina, Briant Anaïs R, Chaigneau Thomas, Kam Wendy, Collet Thierry, Parienti Jean-Jacques, Piquet Marie Astrid, Dupont Benoît
Аннотация
BACKGROUND: Acute cholangitis is an infection due to the bile duct obstruction. Despite progress in treatment, acute cholangitis remains potentially fatal. Early diagnosis and treatment improve the patient outcomes. The present study aimed to identify clinical and biological factors at admission associated with 30-day mortality in acute cholangitis, to build an efficient prognostic score based on these parameters and to study the performances of this new score.
METHODS: We enrolled all adult patients consecutively hospitalized for acute cholangitis between January 2017 and December 2021. We developed a score system named ProChol using variables significantly associated with 30-day mortality in multivariate logistic analysis and simplified this system (named sProChol) based on a simple points-based approach.
RESULTS: In total, 528 patients were included, with an average age of 77 ± 13 years, a male predominance (54.2%) and a majority of lithiasis etiology (66.5%). Mortality in 30 days was 11.9%. In multivariate logistic analysis, tumor etiology [adjusted odds ratio (aOR) = 15.43, 95% confidence interval (CI): 5.90-40.40], stent obstruction (aOR = 5.12, 95% CI: 2.02-12.99), hypoalbuminemia (aOR = 3.50, 95% CI: 1.25-9.81), renal failure (aOR = 6.51, 95% CI: 2.62-16.18), oxygen therapy (aOR = 4.63, 95% CI: 1.02-20.92) and curative anticoagulation (aOR = 2.60, 95% CI: 1.23-5.52) were independently associated with the 30-day mortality while fever was a protective factor (aOR = 0.37, 95% CI: 0.16-0.84). ProChol score using these 7 parameters and sProChol using the 3 robust factors (etiology, renal failure and anticoagulation) presented respectively an area under receiver operating characteristic (ROC) curves (AUC) of 0.81 and 0.77, higher than Tokyo (AUC = 0.72) and Gravito-Soares et al. score (AUC = 0.71). Patients with sProChol ≥ 4 had a significantly higher risk of transfer to intensive care unit (13.3% vs. 5.1%; P < 0.001) and longer length of stay (P = 0.0006).
CONCLUSIONS: ProChol and sProChol constructed from simple clinico-biological parameters at admission, present interesting performances in predicting the 30-day mortality in acute cholangitis.
METHODS: We enrolled all adult patients consecutively hospitalized for acute cholangitis between January 2017 and December 2021. We developed a score system named ProChol using variables significantly associated with 30-day mortality in multivariate logistic analysis and simplified this system (named sProChol) based on a simple points-based approach.
RESULTS: In total, 528 patients were included, with an average age of 77 ± 13 years, a male predominance (54.2%) and a majority of lithiasis etiology (66.5%). Mortality in 30 days was 11.9%. In multivariate logistic analysis, tumor etiology [adjusted odds ratio (aOR) = 15.43, 95% confidence interval (CI): 5.90-40.40], stent obstruction (aOR = 5.12, 95% CI: 2.02-12.99), hypoalbuminemia (aOR = 3.50, 95% CI: 1.25-9.81), renal failure (aOR = 6.51, 95% CI: 2.62-16.18), oxygen therapy (aOR = 4.63, 95% CI: 1.02-20.92) and curative anticoagulation (aOR = 2.60, 95% CI: 1.23-5.52) were independently associated with the 30-day mortality while fever was a protective factor (aOR = 0.37, 95% CI: 0.16-0.84). ProChol score using these 7 parameters and sProChol using the 3 robust factors (etiology, renal failure and anticoagulation) presented respectively an area under receiver operating characteristic (ROC) curves (AUC) of 0.81 and 0.77, higher than Tokyo (AUC = 0.72) and Gravito-Soares et al. score (AUC = 0.71). Patients with sProChol ≥ 4 had a significantly higher risk of transfer to intensive care unit (13.3% vs. 5.1%; P < 0.001) and longer length of stay (P = 0.0006).
CONCLUSIONS: ProChol and sProChol constructed from simple clinico-biological parameters at admission, present interesting performances in predicting the 30-day mortality in acute cholangitis.