Abstract
BackgroundAcute cholangitis is a life-threatening bacterial infection of the biliary tract. Main focus of this study was to create a useful risk prediction model that helps physicians to assign patients with acute cholangitis into different management groups.Methods981 cholangitis episodes from 810 patients were analysed retrospectively at a German tertiary center.ResultsOut of eleven investigated statistical models fit to 22 predictors, the Random Forest model achieved the best (cross-)validated performance to predict mortality. The receiver operating characteristics (ROC) curve revealed a mean area under the curve (AUC) of 91.5 %. Dependent on the calculated mortality risk, we propose to stratify patients with acute cholangitis into a high and low risk group. The mean sensitivity, specificity, positive and negative predictive value of the corresponding optimal cutpoint were 82.9 %, 85.1 %, 19.0 % and 99.3 %, respectively. All of these results emerge from nested (cross-)validation and are supposed to reflect the model’s performance expected for external data. An implementation of our risk prediction model including the specific treatment recommendations adopted from the Tokyo guidelines is available on http://www2.imse.med.tum.de:3838/.ConclusionOur risk prediction model for mortality appears promising to stratify patients with acute cholangitis into different management groups. Additional validation of its performance should be provided by further prospective trails.
Highlights
Acute cholangitis is a life-threatening bacterial infection of the biliary tract ranging from mild symptoms such as fever and/or chills, abdominal pain and jaundice to septic shock [1,2,3,4,5]
All patients included to the study had definitive cholangitis according to the Tokyo guidelines 2013 (TG13)
Patients were recruited as follows: First, our clinical endoscopic database was queried for patients who underwent an endoscopic retrograde cholangiography (ERC) or a percutaneous transhepatic cholangiography (PTC)
Summary
Acute cholangitis is a life-threatening bacterial infection of the biliary tract. Acute cholangitis is a life-threatening bacterial infection of the biliary tract ranging from mild symptoms such as fever and/or chills, abdominal pain and jaundice to septic shock [1,2,3,4,5]. Bacteria reach the biliary system either by ascent from the intestine or by the portal venous system [1]. Inside this biliary stasis the bacteria can Schneider et al BMC Gastroenterology (2016) 16:15 orientation how fast biliary decompression has to be performed and how potent antimicrobial treatment should be. The mortality rate of patients with acute cholangitis was analysed and related to clinical, laboratory and etiological factors
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