Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality in patients over 80 years old

Introduction
This study aims to validate Tokyo guidelines (TG) TG07/TG13/TG18 criteria and identify predictors of in-hospital mortality in acute cholangitis (AC) patients over 80 years old.

Material and methods
This is a retrospective audit of AC patients from January 2009 to December 2016. Demographic, clinical, investigation, management, and mortality data were studied. Multinomial logistic regression analysis with stepwise variable selection identified predictors for in-hospital mortality.

Results
Three hundred and eighty-eight patients were treated for AC. One hundred and sixty-two (41.8%) patients were male. 230 (59.3%) patients had a history of biliary disease, 161 (41.5%) patients had type 2 diabetes mellitus (T2DM), and 98 (25.3%) patients had ischaemic heart disease (IHD). Abdominal pain (n = 226, 58.2%), pyrexia (n = 247, 63.7%), and vomiting (n = 159, 41.0%) were the common presenting symptoms. 191 (49.2%) patients had abdominal tenderness. Positive blood cultures were recorded in patients 158 (40.7%) patients. Escherichia coli was the most commonly identified organism (n = 117, 30.2%). 77 (19.8%), 188 (48.5%) and 123 (31.7%) patients were graded with mild, moderate, and severe AC, respectively. 30-day, 90-day, and in-hospital mortality were 9 (2.3%), 19 (4.9%) and 38 (9.8%), respectively. On multivariate analysis, systolic blood pressure ≤ 100 mmHg (OR = 3.817, 95% CI: 1.365-10.761, p = 0.011), hypoalbuminaemia < 28 gm/l (OR = 6.052, 95% CI: 2.635-13.904, p < 0.001), serum creatinine ≥ 176.8 (OR = 2.787, 95% CI: 1.146-6.778, p = 0.024) and international normalized ratio (INR) > 1.5 (OR = 3.247, 95% CI: 1.234-8.544, p = 0.017) were independent predictors of in-hospital mortality.

Conclusions
Hypotension, hypoalbuminaemia, elevated creatinine, and elevated INR predict in-hospital mortality in AC patients over 80 years old.