The presence of acute cholangitis defined by 2013 Tokyo Guidelines (TG13) in acute necrotising pancreatitis is associated with poor outcomes

Abstract

Background: Is difficult to establish whether acute cholangitis (AC) co-exists as an independent entity with acute necrotising pancreatitis (ANP) owing to overlaping of laboratory liver test results and systemic inflammatory response between entities. Also, the ascending route of the bile duct has been reported as a source of infection in ANP. The aim of our study was to determine whether the presence of AC according to TG13 is associated with poor outcomes in ANP Methods: Data of thirty-seven consecutive patients with ANP from our prospective database were analysed. Outcomes analysed were: persistent organ failure (POF), persisten multi-organ failure (PMOF), mortality, duration of hospital stay, intensive care unit (ICU) admission, infected pancreatic necrosis (IPN) with positive culture after necrosectomy, and need for an interventional procedure against necrosis. AC was defined according to TG13 in all patients between admission and the first week post ANP onset Results: A positive TG13 AC was found in 7(18.9%) patients, and was associated with POF (71.1% vs. 20%, p=0.016), PMOF (57.1% vs. 13.3%, p=0.027), ICU admission (57.1% vs. 13.3%, p=0.027), mechanical ventilation (57.1% vs 10%, p=0.015), and IPN (42.9% vs. 6.7%, p=0.037). No association was found regarding hospital stay, need for an interventional procedure and mortality Conclusion: In our series, ANP with acute cholangitis defined by TG13 is associated with poor outcomes, including necrosis infection. Large series are needed to confirm these findings