Abstract
Background/purpose
The Tokyo Guidelines (TG) have enabled more accurate diagnosis of acute cholangitis (AC). This study was undertaken to develop a new prognostic scoring system to predict the need for urgent endoscopic retrograde cholangiopancreatography (ERCP) based on the clinical findings on admission.
Methods
We prospectively reviewed 40 consecutive cases of AC and divided them into an urgent-ERCP group and an elective-ERCP group.
Results
Univariate analysis identified four factors that predicted the need for urgent ERCP: serum albumin level below 3.0 g/dl, blood urea nitrogen level above 20 mg/dl, platelet count below 120,000/μl, and the presence of systemic inflammatory response syndrome. These four predictors plus four predictors of organ dysfunction in the TG: shock, consciousness disturbance, respiratory failure, and prothrombin time/international normalized ratio >1.5, were used to devise a scoring system in which 1 point was assigned for the first four predictors and 2 points were assigned for the latter four predictors (maximum score possible: 12 points). The receiver-operator characteristic curve of the scores showed good test performance for predicting the need for urgent ERCP and for predicting a positive blood culture, and the areas under the concentration curves (AUCs) were 0.96 and 0.97, respectively. The optimal cut-off value for urgent ERCP was 2 points.
Conclusions
This new simple scoring system allows identification of high-risk AC patients soon after admission to hospital.
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References
Rogers L. Biliary abscess of the liver with operation. Br Med J. 1903;2:706–7.
Saik RP, Greenburg AG, Peskin GW. Cholecystostomy hazard in acute cholangitis. J Am Med Assoc. 1976;235:2412–3.
Boey JH, Way LW. Acute cholangitis. Ann Surg. 1980;191:264–70.
Reynolds BM, Dargan EL. Acute obstructive cholangitis. Ann Surg. 1959;150:299–303.
Hui CK, Lai KC, Yuen MF, Ng M, Lai CL, Lam SK. Acute cholangitis-predictive factors for emergency ERCP. Aliment Pharmacol Ther. 2001;15:1633–7.
Salek J, Livote E, Sideridis K, Bank S. Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis. J Clin Gastroenterol. 2009;43:171–5.
Gigot JF, Leese T, Dereme T, Coutinho J, Castaing D, Bismuth H. Acute cholangitis multivariate analysis of risk factors. Ann Surg. 1989;209:435–8.
Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:52–8.
Sekimoto M, Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, et al. Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Surg. 2007;14:11–4.
Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, Hirota M, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:27–34.
Lai EC, Mok FP, Tan ES. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. 1992;326:1582–6.
Sugiyama M, Atomi Y. Treatment of acute cholangitis due to choledocholithiasis in elderly and young patients. Arch Surg. 1997;132:1129–33.
Shimada H, Nakagawara G, Kobayashi M, Tsuchiya S, Kudo T, Morita S. Pathogenesis and clinical features of acute cholangitis accompanied by shock. Jpn J Surg. 1984;14:269–77.
Thompson J, Bennion RS, Patt HA. An analysis of infectious failures in acute cholangitis. HPB Surgery. 1994;8:139–44.
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Nishino, T., Onizawa, S., Hamano, M. et al. Proposed new simple scoring system to identify indications for urgent ERCP in acute cholangitis based on the Tokyo Guidelines. J Hepatobiliary Pancreat Sci 19, 698–706 (2012). https://doi.org/10.1007/s00534-011-0488-0
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DOI: https://doi.org/10.1007/s00534-011-0488-0