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Multicenter Study
. 2021 Feb 6;25(1):49.
doi: 10.1186/s13054-021-03480-1.

Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

Jean-Rémi Lavillegrand  1   2   3 , Emmanuelle Mercier-Des-Rochettes  4 , Elodie Baron  5 , Frédéric Pène  5 , Damien Contou  6 , Raphael Favory  7 , Sébastien Préau  7 , Arnaud Galbois  8 , Chloé Molliere  8 , Arnaud-Félix Miailhe  9 , Jean Reignier  9 , Mehran Monchi  4 , Claire Pichereau  10 , Sara Thietart  1 , Thibault Vieille  11 , Gael Piton  11 , Gabriel Preda  12 , Idriss Abdallah  13 , Marine Camus  2   14 , Eric Maury  1   2 , Bertrand Guidet  1   2 , Guillaume Dumas  1   2 , Hafid Ait-Oufella  15   16   17
Affiliations
Multicenter Study

Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

Jean-Rémi Lavillegrand et al. Crit Care. .

Abstract

Background: Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC).

Methods: Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis.

Results: Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5-11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50-147] and 19.1 µg/L [5.3-54.8]. Sixty-three percent of patients (n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54-0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05-1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08-1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12-1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones (p < 0.05) and AC complications (OR 2.74 [95% CI 1.45-5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30-6.22], p = 0.02).

Conclusions: In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.

Keywords: Cholangitis; Intensive care unit; Microbiology; Outcome; Prognosis.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Observed annual percentage of Extended spectrum beta lactamase producing bacterial infections on documented acute cholangitis in ICUs. The line is a linear regression with 95% CIs
Fig. 2
Fig. 2
Factors associated with in-hospital mortality (multivariate analysis)
Fig. 3
Fig. 3
Adjusted probability of in-hospital mortality across years
Fig. 4
Fig. 4
Adjusted effects of time from admission to biliary drainage on hospital mortality, SOFA score at day 0, cause of biliary obstacle, locoregional complications, PT < 50% and appropriate empirical antibiotic therapy
See this image and copyright information in PMC

References

    1. Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos) J Hepatobiliary Pancreat Sci. 2018;25:17–30. doi: 10.1002/jhbp.512. - DOI - PubMed
    1. Leligdowicz A, Dodek PM, Norena M, Wong H, Kumar A, Kumar A. Association between source of infection and hospital mortality in patients who have septic shock. Am J Respir Crit Care Med. 2014;189:1204–1213. doi: 10.1164/rccm.201310-1875OC. - DOI - PubMed
    1. Baykara N, Akalın H, Arslantaş MK, Hancı V, Çağlayan Ç, Kahveci F, et al. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study. Crit Care. 2018;22:93. doi: 10.1186/s13054-018-2013-1. - DOI - PMC - PubMed
    1. Annane D, Aegerter P, Jars-Guincestre MC, Guidet B. Current epidemiology of septic shock: the CUB-Réa network. Am J Respir Crit Care Med. 2003;168:165–172. doi: 10.1164/rccm.2201087. - DOI - PubMed
    1. SepNet Critical Care Trials Group Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med. 2016;42:1980–1989. doi: 10.1007/s00134-016-4504-3. - DOI - PubMed

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