Association between early ERCP and mortality in patients with acute cholangitis

Abstract

Acute cholangitis (AC) is associated with high mortality of up to 10%. The association between timing of ERCP and mortality in patients with AC remains unclear. The aim of this study was to investigate whether early ERCP within 24 hours was associated with improved survival. All patients who underwent ERCP at Odense University Hospital, Denmark, between March 2009 and September 2016 were identified using a prospective ERCP database. Clinical data were collected from medical records. Patients fulfilling the Tokyo Guidelines 2013 criteria and for whom a detailed review of medical records revealed evidence of AC were included. We investigated the association between ERCP within 24 hours and 30-day mortality using logistic regression analysis with adjustment for confounding factors. A total of 4066 consecutive patients underwent ERCP during the study period, and 166 patients fulfilled the inclusion criteria. Forty-eight patients (29%) underwent ERCP within 24 hours from the time of hospitalization, and 118 patients (71%) underwent later ERCP. Patients undergoing ERCP within 24 hours were younger (medians: 65 vs 73 years; P= .01) and had a higher heart rate (medians: 95 vs 90 beats/minute; P= .02). Overall 30-day mortality was 16% (n= 27). Mortality was 8% (n= 4) among patients undergoing early ERCP and 19% (n= 23) among patients undergoing later ERCP (P= .10). After adjustment for confounding factors, performance of ERCP within 24 hours was associated with lower 30-day mortality (odds ratio, 0.23; 95% confidence interval, 0.05-0.95; P= .04). Our results indicate that early ERCP within 24 hours is associated with lower 30-day mortality in patients with AC.