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Should lactate be added to Tokyo criteria for the evaluation of patients with acute cholangitis?

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Abstract

Background

Tokyo guidelines (TG13/18) are used for the severity assessment of acute cholangitis (AC). Lactate is a clinical marker of tissue hypoxia and disease severity, independent from blood pressure.

Aim

The aim of this study is to investigate the relationship between blood lactate level and TG13/18 criteria in patients diagnosed with AC.

Methods

One hundred fifteen patients with AC were included in this retrospective study. Demographic characteristics of the patients and laboratory data were scanned from their hospital medical records. According to TG13/18 guidelines, the patients were divided into 3 groups as mild (grade 1), moderate (grade 2), and severe (grade 3) AC.

Results

Sixty three (54.7%) of the patients were grade 1, 37 (32.1%) were grade 2, and 15 (13.0%) were grade 3. It was found that blood lactate level increased significantly from grade 1 to grade 3 (p < 0.001). In logistic regression analysis, white blood cell (WBC) count, total bilirubin and blood lactate levels independently determined the patients to be grade 2 or 3 AC. When the blood lactate cut-off value was taken as 16.5 mg/dL, we diagnosed grade 2 or 3 AC with a sensitivity of 78.8% and a specificity of 75.7%. From among lactate, WBC, and C reactive protein, lactate showed the highest value regarding the area under the curve, which is an index for predicting grade III upon ROC analysis.

Conclusion

The blood lactate level is associated with the severity of AC. In addition to TG13/18 guidelines, blood lactate level can be a useful biomarker in the severity grading of AC.

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References

  1. Tan M, Jensen TG, Nielsen SL et al (2021) Analysis of patterns of bacteremia and 30-day mortality in patients with acute cholangitis over a 25-year period. Scand J Gastroenterol 56(5):578–584. https://doi.org/10.1080/00365521.2021.1902558. Epub 2021 Mar 25

    Article  CAS  PubMed  Google Scholar 

  2. Shenoy SM, Shenoy S, Gopal, S et al (2014) Clinicomicrobiological analysis of patients with cholangitis. Indian J Med Microbiol 32(2):157–60. https://doi.org/10.4103/0255-0857.129802

  3. Park JW, Lee JK, Lee KT et al (2014) How to interpret the bile culture results of patients with biliary tract infections. Clin Res Hepatol Gastroenterol 38:300–309

    Article  Google Scholar 

  4. Kiriyama S, Takada T, Strasberg SM et al (2013) Tokyo Guidelines Revision Committee. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos) J Hepatobiliary Pancreat Sci 20:24–34. https://doi.org/10.1007/s00534-012-0561-3

  5. Kiriyama S, Kozaka K, Takada T et al (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos) J Hepatobiliary Pancreat Sci 25:17–30. https://doi.org/10.1002/jhbp.512. Epub 2018 Jan 5

  6. Jones AE, Puskarich MA (2009) Sepsis-induced tissue hypoperfusion. Crit Care Clin 25(4):769–779

    Article  CAS  Google Scholar 

  7. Andersen LW, Mackenhauer J, Roberts JC et al (2013) Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc 88(10):1127–1140

    Article  CAS  Google Scholar 

  8. Gravito-Soares E, Gravito-Soares M, Gomes D et al (2018) Clinical applicability of Tokyo guidelines 2018/2013 in diagnosis and severity evaluation of acute cholangitis and determination of a new severity model. Scand J Gastroenterol 53(3):329–334. https://doi.org/10.1080/00365521.2018.1430255. Epub 2018 Jan 29

    Article  PubMed  Google Scholar 

  9. Kiriyama S, Takada T, Hwang TL et al (2017) Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. J Hepatobiliary Pancreat Sci 24(6):329–337. https://doi.org/10.1002/jhbp.458. Epub 2017 May 29

    Article  PubMed  Google Scholar 

  10. Umefune G, Kogure H, Hamada T et al (2017) Procalcitonin is a useful biomarker to predict severe acute cholangitis: a single-center prospective study. J Gastroenterol 52(6):734–745. https://doi.org/10.1007/s00535-016-1278-x. Epub 2016 Oct 25

    Article  CAS  PubMed  Google Scholar 

  11. Beliaev AM, Booth M, Rowbotham D et al (2018) Diagnostic inflammatory markers in acute cholangitis. J Surg Res 228:35–41. https://doi.org/10.1016/j.jss.2018.02.048. Epub 2018 Mar 26

    Article  CAS  PubMed  Google Scholar 

  12. Lee YS, Cho KB, Park KS et al (2018) Procalcitonin as a decision-supporting marker of urgent biliary decompression in acute cholangitis. Dig Dis Sci 63(9):2474–2479. https://doi.org/10.1007/s10620-018-4963-1

    Article  CAS  PubMed  Google Scholar 

  13. Karpel E, Madej A, Bułdak Ł et al (2011) Bile bacterial flora and its in vitro resistance pattern in patients with acute cholangitis resulting from choledocholithiasis. Scand J Gastroenterol 46(7–8):925–930. https://doi.org/10.3109/00365521.2011.560676. Epub 2011 Apr 20 PMID: 21504380

    Article  CAS  PubMed  Google Scholar 

  14. Kimura Y, Takada T, Kawarada Y et al (2007) Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14:15–26. https://doi.org/10.1007/s00534-006-1152-y. Epub 2007 Jan 30

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zhu Y, Tu J, Zhao Y et al (2021) Association of timing of biliary drainage with clinical outcomes in severe acute cholangitis: a retrospective cohort study. Int J Gen Med 28(14):2953–2963. https://doi.org/10.2147/IJGM.S315306

    Article  Google Scholar 

  16. Khosravani H, Shahpori R, Stelfox HT et al (2009) Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Critical care (London, England) 13(3):R90

    Article  Google Scholar 

  17. Kruse O, Grunnet N, Barfod C (2011) Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 19(1):74. https://doi.org/10.1186/1757-7241-19-74.42

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mikkelsen ME, Miltiades AN, Gaieski DF et al (2009) Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 37(5):1670–1677. https://doi.org/10.1097/CCM.0b013e31819fcf68

    Article  CAS  PubMed  Google Scholar 

  19. Shapiro NI, Trzeciak S, Hollander JE et al (2009) A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis. Crit Care Med 37(1):96–104. https://doi.org/10.1097/CCM.0b013e318192fd9d

    Article  PubMed  Google Scholar 

  20. Vincent JL, Silva AQ, Couto L Jr et al (2016) The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 20:257

    Article  Google Scholar 

  21. Tsuyuguchi T, Sugiyama H, Sakai Y et al (2012) Prognostic factors of acute cholangitis in cases managed using the Tokyo guidelines. J Hepatobiliary Pancreat Sci 19(5):557–565. https://doi.org/10.1007/s00534-012-0538-2

    Article  PubMed  Google Scholar 

  22. Bolton JD (2007) Clinical use of lactate testing in shock states. Seminars in Anesthesia, Perioperative Medicine and Pain 26(1):35–39

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey

    Erdinc Gulumsek, Banu Kara & Adnan Tas

  2. Department of Medical Biochemistry, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey

    Fatih Yesildal

  3. Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey

    Ismail Yigitdol, İbrahim Erdem, Huseyin Can Arbag, Tayyibe Saler & Hilmi Erdem Sumbul

  4. Department of Emergency Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey

    Akkan Avci

Authors
  1. Erdinc Gulumsek
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  2. Fatih Yesildal
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  3. Ismail Yigitdol
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  4. İbrahim Erdem
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  5. Huseyin Can Arbag
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  6. Akkan Avci
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  7. Tayyibe Saler
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  8. Banu Kara
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  9. Adnan Tas
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  10. Hilmi Erdem Sumbul
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Contributions

Conceptualization: [Gulumsek Erdinc, Yesildal Fatih, Sumbul Hilmi Erdem, Tas Adnan, Kara Banu, Saler Tayyibe]; Methodology: [Gulumsek Erdinc, Sumbul Hilmi Erdem, Avci Akkan, Yesildal Fatih]; Formal analysis and investigation: [Yigitdol Ismail, Erdem Ibrahim, Arbag Huseyin Can]; Writing—original draft preparation: [Sumbul Hilmi Erdem, Gulumsek Erdinc]; Writing—review and editing: [Avci Akkan, Tas Adnan, Kara Banu, Saler Tayyibe]; Funding acquisition: [None]; Resources: [None]; Supervision: [Sumbul Hilmi Erdem, Saler Tayyibe, Avci Akkan, Tas Adnan, Kara Banu]. All authors contributed to the study conception and design, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hilmi Erdem Sumbul.

Ethics declarations

Ethics approval

The study was approved by the institutional ethics committee (registration number 106 dated 4.12.2020). The study was performed according to the recommendations set by the Declaration of Helsinki on Medical Research involving Human Subjects. This manuscript was carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.

Informed consent

Consent forms were obtained because this study was planned a retrospective study.

Conflict of interest

The authors declare no competing interests.

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Gulumsek, E., Yesildal, F., Yigitdol, I. et al. Should lactate be added to Tokyo criteria for the evaluation of patients with acute cholangitis?. Ir J Med Sci 191, 1177–1183 (2022). https://doi.org/10.1007/s11845-022-02941-y

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  • DOI: https://doi.org/10.1007/s11845-022-02941-y

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