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Gastroenterology Review/Przegląd Gastroenterologiczny
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Artykuł oryginalny

Early biliary drainage is associated with favourable outcomes in critically-ill patients with acute cholangitis

Mohammed Aboelsoud, Osama Siddique, Alexander Morales, Young Seol, Mazen Al-Qadi

Data publikacji online: 2018/03/26
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Acute cholangitis (AC) is a clinical condition that requires prompt medical management with IV fluids, antibiotics, and biliary drainage (BD). The optimal timing for BD remains unclear.

To investigate the effect of biliary drainage timing on clinical outcomes in AC.

Material and methods
We conducted a retrospective study of patients with AC admitted to the ICU using the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database. Emergency department to BD time, hospital death, length of stay (LOS), and severity scores were extracted from the database. We investigated the effect of BD timing on mortality rates, persistent organ failure, and LOS.

A total of 177 patients were included; 50% were males; median age was 75 years, in-hospital mortality was 9.6%, mean time-to-ERCP was 32 h (range: 0.42–229.6) with 76% meeting the Tokyo Guidelines (TG13) criteria for severe cholangitis, and median Simplified Acute Physiology Score II (SAPS II) was 42 (IQR: 33–51). Using 24 h as a cut-off, patients who underwent BD ≤ 24 h had less persistent organ failure (OR = 0.49; 95% CI: 0.26–0.96, p = 0.040), shorter ICU LOS (3.25 vs. 4.95 days, p = 0.040), shorter hospital LOS (7.71 vs. 13.57 days, p = 0.001), but no difference in either in-hospital mortality (OR = 0.47, 95% CI: 0.17–1.29, p = 0.146) or 28-day mortality (OR = 0.61, 95% CI: 0.24–1.53, p = 0.297).

In critically-ill patients with acute cholangitis, early biliary drainage ≤ 24 h is associated with less persistent organ failure and shorter length of stay but had no effect on patient survival.

Rosing DK, De Virgilio C, Nguyen AT, et al. Cholangitis: analysis of admission prognostic indicators and outcomes. Am Surg 2007; 73: 949-54.
Salek J, Livote E, Sideridis K, et al. Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis. J Clin Gastroenterol 2009; 43: 171-5.
Khashab MA, Tariq A, Tariq U, et al. Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis. Clin Gastroenterol Hepatol 2012; 10: 1157-61.
Navaneethan U, Gutierrez NG, Jegadeesan R, et al. Factors predicting adverse short-term outcomes in patients with acute cholangitis undergoing ERCP: a single center experience. World J Gastrointest Endosc 2014; 6: 74-81.
Hui CK, Lai KC, Yuen MF, et al. Acute cholangitis: predictive factors for emergency ERCP. Aliment Pharmacol Ther 2001; 15: 1633-7.
Kinney TP. Management of ascending cholangitis. Gastrointest Endosc Clin N Am 2007; 17: 289-306.
Kimura Y, Takada T, Kawarada Y, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 15-26.
Kiriyama S, Takada T, Strasberg SM, et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013; 20: 24-34.
Lai EC, Mok FP, Tan ES, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 1992; 326: 1582-6.
Sung JJ, Leung JC, Tsui CP, et al. Biliary IgA secretion in obstructive jaundice: the effects of endoscopic drainage. Gastrointest Endosc 1995; 42: 439-44.
Lau JY, Chung SC, Leung JW, et al. Endoscopic drainage aborts endotoxaemia in acute cholangitis. Br J Surg 1996; 83: 181-4.
Mok SR, Mannino CL, Malin J, et al. Does the urgency of endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous biliary drainage (PBD) impact mortality and disease related complications in ascending cholangitis? (DEIM-I study). J Interv Gastroenterol 2012; 2: 161-7.
Lee F, Ohanian E, Rheem J, et al. Delayed endoscopic retrograde cholangiopancreatography is associated with persistent organ failure in hospitalised patients with acute cholangitis. Aliment Pharmacol Ther 2015; 42: 212-20.
Inamdar S, Sejpal DV, Ullah M, et al. Weekend vs. weekday admissions for cholangitis requiring an ERCP: comparison of outcomes in a national cohort. Am J Gastroenterol 2016; 111: 405-10.
Saeed M, Villarroel M, Reisner AT, et al. Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II): a public-access intensive care unit database. Crit Care Med 2011; 39: 952-60.
Chak A, Cooper GS, Lloyd LE, et al. Effectiveness of ERCP in cholangitis: a community-based study. Gastrointest Endosc 2000; 52: 484-9.
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