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Procalcitonin as a Decision-Supporting Marker of Urgent Biliary Decompression in Acute Cholangitis

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Abstract

Background and Aim

This study aimed to evaluate the association of serum procalcitonin (PCT) at hospital presentation with disease severity and clinical deterioration to septic shock in acute cholangitis.

Methods

This study included consecutive patients with a diagnosis of acute cholangitis who presented to the emergency department and underwent biliary drainage. PCT and blood culture tests were conducted at the time of initial presentation. Patients were categorized into three groups based on disease severity. White blood cell count, levels of C-reactive protein and PCT were compared regarding the following: cholangitis severity, blood culture positivity, and clinical deterioration to septic shock.

Results

A total of 204 consecutive patients were enrolled, with grade I severity in 39 (19.1%), grade II in 139 (68.1%), and grade III in 26 (12.7%). The numbers of patients with blood culture positivity and clinical deterioration were 6 (15.4%) and 1 (2.6%) in grade I, 45 (32.4%) and 4 (2.9%) in grade II, and 14 (53.8%) and 1 (5.6%) in grade III cholangitis, respectively. Only PCT was significantly associated with blood culture positivity (3.25 vs 0.62 ng/mL; P = 0.001) and clinical deterioration (9.11 vs 0.89 ng/mL; P = 0.040). The cutoff value of PCT for clinical deterioration to septic shock among patients with grade I and II was 3.77 ng/mL (sensitivity of 80.0% and specificity of 74.0%).

Conclusion

PCT could be a promising marker of clinical deterioration to septic shock in acute cholangitis. Therefore, PCT might be used as a decision-supporting biomarker for urgent biliary decompression.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP; Ministry of Science, ICT & Future Planning) (No. 2017R1C1B5018180) and by the Keimyung University Research Grant of 2016.

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Authors and Affiliations

  1. Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, South Korea

    Yoon Suk Lee

  2. Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, South Korea

    Kwang Bum Cho, Kyung Sik Park, Ju Yup Lee & Yoo Jin Lee

Authors
  1. Yoon Suk Lee
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  2. Kwang Bum Cho
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  3. Kyung Sik Park
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  4. Ju Yup Lee
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Contributions

Yoon Suk Lee was involved in study concept and design, data acquisition and interpretation, and drafting of the manuscript; Ju Yup Lee and Yoo Jin Lee were involved in data acquisition; Kyung Sik Park and Kwang Bum Cho supervised the study and critically reviewed the manuscript

Corresponding author

Correspondence to Kwang Bum Cho.

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The authors declare that they have no conflict of interest.

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Lee, Y.S., Cho, K.B., Park, K.S. et al. Procalcitonin as a Decision-Supporting Marker of Urgent Biliary Decompression in Acute Cholangitis. Dig Dis Sci 63, 2474–2479 (2018). https://doi.org/10.1007/s10620-018-4963-1

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  • DOI: https://doi.org/10.1007/s10620-018-4963-1

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