Abstract
BackgroundLittle is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC).MethodsRetrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis.ResultsOverall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients (n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12–1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones (p < 0.05) and AC complications (OR 2.74 [95% CI 1.45–5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02).ConclusionsIn this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.
Highlights
Acute cholangitis (AC), called ascending cholangitis, is a bacterial infection of the biliary system, due to partial or complete obstruction of the bile duct or hepatic ducts
Our study aimed to describe over a 14-year period the demographical, clinical and microbial patterns of critically ill patients admitted in Intensive Care unit (ICU) for AC, to describe therapeutic management and analyze risk factors for in-hospital mortality, including time to biliary decompression
Additional files 1 and 2) for acute cholangitis were identified by searching hospital databases for codes K803 or K830 as a principal or associated diagnosis according to the International Classification of Diseases (10th version)
Summary
Acute cholangitis (AC), called ascending cholangitis, is a bacterial infection of the biliary system, due to partial or complete obstruction of the bile duct or hepatic ducts. AC diagnosis and management should be considered as an emergency because it may be responsible for lifethreatening organ failure and death. Intensive Care unit (ICU) admission of patients with AC is not rare, as it is responsible for 5% of septic shocks [2] and for 10 to 29% of intra-abdominal sepsis [3,4,5]. The cornerstone of the management of AC is based on fluid resuscitation, antibiotics, organ support therapy, and biliary drainage. Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC)
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