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Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage

  • Clinical Investigation
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Abstract

Objectives

To prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD).

Methods

Institutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF.

Results

Fourteen (14.4 %) patients developed IF and 17 (17.5 %) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95 % CI 2.658–1510.055; P = 0.010) and low INR (OR 4.7 × 10−4; 95 % CI 0.000–0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95 % CI 1.161–17.992; P = 0.030).

Conclusions

The amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.

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Abbreviations

PTBD:

Percutaneous transhepatic biliary drainage

IR:

Interventional radiology

IF:

Immediate fever

DOF:

Delayed-onset fever

ERCP:

Endoscopic retrograde cholangiopancreatography

CT:

Computed tomography

MR:

Magnetic resonance

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

ALP:

Alkaline phosphatase

GGT:

Gamma glutamyl transpeptidase

WBC:

White blood cell

INR:

Prothrombin time

ECG:

Electrocardiography

SpO2 :

Oxygen saturation

NIBP:

Non-invasive blood pressure

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Author notes

    Authors and Affiliations

    1. Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

      Pierleone Lucatelli, Mario Corona, Luca Ginanni Corradini, Carlo Cirelli, Fabrizio Fanelli, Mario Bezzi & Carlo Catalano

    2. Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy

      Stefano Ginanni Corradini & Edoardo Poli

    3. Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy

      Luca Saba

    4. Department of Vascular Interventional Radiology of the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

      Haofan Wang

    Authors
    1. Pierleone Lucatelli
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    2. Stefano Ginanni Corradini
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    3. Mario Corona
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    4. Luca Ginanni Corradini
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    5. Carlo Cirelli
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    6. Luca Saba
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    7. Edoardo Poli
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    8. Fabrizio Fanelli
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    9. Haofan Wang
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    10. Mario Bezzi
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    11. Carlo Catalano
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    Correspondence to Pierleone Lucatelli.

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    Conflict of interest

    For all authors, there is no potential conflict of interest that could be perceived to bias our work. Authors had full control of all the data and information presented in this manuscript.

    Ethical Approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Pierleone Lucatelli and Stefano Ginanni Corradini have been contributed equally to this work.

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    Cite this article

    Lucatelli, P., Corradini, S.G., Corona, M. et al. Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage. Cardiovasc Intervent Radiol 39, 746–755 (2016). https://doi.org/10.1007/s00270-015-1242-9

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    • DOI: https://doi.org/10.1007/s00270-015-1242-9

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