Abstract
Background Severe acute cholangitis is a life-threatening biliary infection, leading to organ dysfunction, septic shock, and naturally death. Mortality has dropped significantly in the past years through improving resuscitation and biliary drainage techniques. The aim of our study is to analyze our daily practice and the factors associated with mortality. Methods A retrospective study including severe acute cholangitis patients admitted to our unit from January 2009 to December 2018. Variables analyzed (univariate then multivariate analysis) were age, sex, history, origin, evolution time, bilirubin, etiology, organ dysfunction, qSOFA, SOFA, TOKYO, biliary drainage timing and technique, shock, antibiotherapy, and resuscitation. Results 140 patients were included in this study. Average age was 61. Sex ratio M/F was 0.59. Lithiasis etiology was dominant (69%). SOFA average score upon admission was 8. Ceftriaxone + metronidazole was the empirical antibiotic used in 87%. Average time to biliary drainage was 1.58 ± 0.89 days. Endoscopic unblocking was the technique used in 76%. Mean duration of ICU stay was 6 days. Mortality rate was 28%. Statistically significant factors for mortality (p < 0.05) were history of taking anticoagulant treatment, use of catecholamines and mechanical ventilation during ICU stay, and delay in consultation and administration of antibiotic therapy. Conclusions Early recognition, antibiotics, resuscitation, and minimally invasive biliary drainage have improved patient outcomes although there is still progress to be made. Moreover, as multiple organ failure is often associated with mortality in severe acute cholangitis, predictive risk factors of organ failure should be more investigated.
Highlights
Acute cholangitis is a bacterial infection of the biliary tract following cholestasis mainly caused by lithiasic or tumoral biliary obstruction
In this retrospective observational monocentric study, we evaluated patients of age ≥ 16 years with severe acute cholangitis admitted to our Intensive Care Unit (ICU) between January 2009 and December 2018
Acute cholangitis was lithiasic in most cases (69%), tumoral (15%), hydatic (13%), inflammatory, and iatrogenic in the other cases
Summary
Acute cholangitis is a bacterial infection of the biliary tract following cholestasis mainly caused by lithiasic or tumoral biliary obstruction. Diagnosis and recognition of severe presentations are a challenging task for every clinician in order to initiate an early and appropriate therapeutic management This management is continuously progressing in terms of resuscitation, antibiotics, surgical techniques, and less invasive techniques such as interventional endoscopy and radiology. Resuscitation, antibiotics, and biliary drainage as an early intervention approach are absolutely essential for survival in severe acute cholangitis. Our aim in this study was to identify the factors associated to mortality in severe acute cholangitis in our context. Variables analyzed (univariate multivariate analysis) were age, sex, history, origin, evolution time, bilirubin, etiology, organ dysfunction, qSOFA, SOFA, TOKYO, biliary drainage timing and technique, shock, antibiotherapy, and resuscitation. As multiple organ failure is often associated with mortality in severe acute cholangitis, predictive risk factors of organ failure should be more investigated
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