Outcomes of Acute Cholangitis in Maharat Nakhon Ratchasima Hospital
A Retrospective Review
Keywords:
CholangitisAbstract
Introduction: Acute cholangitis is a common biliary tract infection which has a high mortality rate, especially in severe cholangitis. The recommended treatments are emergent or urgent biliary drainage. The therapeutic procedure of choice is endoscopic retrograde cholangiopancreatography (ERCP). The second choice is percutaneous biliary drainage (PTBD) and surgical biliary decompression. Due to the limited resources for ERCP and radiologists that may perform PTBD in the Maharat Nakhon Ratchasima Hospital (MNRH), the aim of this study was to review the outcomes of cholangitis treatment and factors associated to mortality in MNRH.
Meterials and Methods: This study reviewed medical records of all patients who were newly diagnosed with acute cholangitis at Maharat Nakhon Ratchasima Hospital between January 1st, 2017 and December 31st, 2017. Logistic regression was used to analyze factors associated with mortality and effect size was reported as odds ratio with 95% confidence interval. A p-value less than 0.05 was considered as statistically significant.
Results: The medical records review of 250 acute cholangitis patients indicated that the overall mortality was 11.2% (almost all of whom had severe acute cholangitis). The overall mortality rates of patients who were treated by minimally invasive biliary drainage, antibiotics alone, or open surgical drainage were 4.6%, 10.7% and 31.6% respectively. Independent factors associated with mortality were severe acute cholangitis (OR= 61.20; 95% CI: 7.84 to 478; p < 0.01), surgical drainage (OR= 6.60; 95% CI 1.30 to 33.48; p = 0.02), and non-stone etiology (OR= 4.07; 95% CI 1.28 to 12.94; p = 0.02).
Conclusion: Minimally invasive biliary drainage should be a procedure of choice for biliary drainage in acute cholangitis due to its lower mortality compared to open surgical drainage. Open surgical drainage should be reserved when other preferred methods are not available.
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