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Prognostic factors of acute cholangitis in cases managed using the Tokyo Guidelines

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

In 2007, the Tokyo Guidelines (TG07) working group established diagnostic criteria for assessment of the severity of acute cholangitis. This study aimed to analyze outcomes and identify predictors of mortality in patients with acute cholangitis managed according to the TG07.

Methods

In this study, 215 consecutive cases of acute cholangitis were reviewed. Risk factors associated with mortality or refractory cholangitis, which is defined on the basis of prolonged hospitalization (>28 days) or disease resulting in fatality, were examined using multivariate logistic regression analysis.

Results

There were 52, 133, and 30 cases of mild, moderate, and severe cholangitis, respectively. The overall mortality rate was 4.2 % (9/215). Mortality rates in patients with mild, moderate, and severe cholangitis were 0, 2.3, and 20.0 %, respectively (moderate vs. severe, p = 0.001). Multivariate analysis showed that serum albumin levels ≤2.8 g/dl and PT-INR >1.5 were significant predictors of mortality. There were 57 patients (26.5 %) with refractory cholangitis. Multivariate analysis showed that serum albumin level ≤2.8 g/dl, PT-INR >1.5, etiology and inpatient status were significant predictors of refractory cholangitis.

Conclusions

The TG07 severity assessment criteria for acute cholangitis were significantly predictive of mortality. Hypoalbuminemia is an important risk factor in addition to organ dysfunction.

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Abbreviations

EBD:

Endoscopic biliary drainage

TG07:

Tokyo Guidelines

PTBD:

Percutaneous transhepatic biliary drainage

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Authors and Affiliations

  1. Department of Gastroenterology and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Toshio Tsuyuguchi, Harutoshi Sugiyama, Yuji Sakai, Takao Nishikawa & Osamu Yokosuka

  2. Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan

    Toshihiko Mayumi

  3. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan

    Seiki Kiriyama

  4. General Internal Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan

    Masamichi Yokoe

  5. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Tadahiro Takada

Authors
  1. Toshio Tsuyuguchi
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  2. Harutoshi Sugiyama
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  3. Yuji Sakai
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  4. Takao Nishikawa
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  5. Osamu Yokosuka
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  6. Toshihiko Mayumi
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  7. Seiki Kiriyama
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  8. Masamichi Yokoe
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  9. Tadahiro Takada
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Corresponding author

Correspondence to Toshio Tsuyuguchi.

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Tsuyuguchi, T., Sugiyama, H., Sakai, Y. et al. Prognostic factors of acute cholangitis in cases managed using the Tokyo Guidelines. J Hepatobiliary Pancreat Sci 19, 557–565 (2012). https://doi.org/10.1007/s00534-012-0538-2

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  • DOI: https://doi.org/10.1007/s00534-012-0538-2

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