Risk factors of organ failure in cholangitis with bacteriobilia

Table 1 Baseline characteristics of patients with acute cholangitis who underwent percutaneous transhepatic biliary drainage (n = 182)

Characteristic	n (%)
Age ≥ 65 yr	95 (52.2)
Sex (male/female)	111/71
Heavy smoker 1	12 (12.1)
Heavy alcohol drinker 2	17 (9.3)
Body temperature > 38 or < 36  °C	61 (33.5)
Positive Charcot’s triad	23 (12.6)
Symptom to door time (h), mean ± SD	107.2 ± 171.2
CCIs ≥ 4	90 (49.5)
Pre-existing renal dysfunction	14 (7.7)
Etiology
Choledocholithiasis	59 (32.4)
Benign biliary stricture	31 (17.0)
Malignant biliary obstruction	88 (48.4)
Procedure-related	4 (2.2)
Laboratory finding
WBC count > 12000 or < 4000/mm3	70 (38.5)
Total bilirubin ≥ 5 mg/dL	59 (32.4)
Alkaline phosphatase ≥ 250 IU/L	106 (58.2)
Albumin ≤ 2.8 g/dL	59 (32.4)
C-reactive protein ≥ 5 mg/dL	120 (65.9)
The severity of acute cholangitis3
Mild	73 (40.1)
Moderate	64 (35.2)
Severe	45 (24.7)
Performance of bile cultures	138 (75.8)
During PTBD insertion	58
Within 24 h after PTBD insertion	80
Positive blood culture	55/182 (30.2)
Unsuccessful biliary decompression4	14 (7.7)
Reposition	6
Additional insertion	8
Organ failure	24 (13.2)
Septic shock	13
Acute renal failure	8
Acute respiratory distress	3
Death	5 (2.7)

Values are presented as number or number (%).

¹Heavy smoker is defined as an individual with 20 or more pack-years (1 pack year = 1 pack per day for one year) of use;

²Heavy drinker is defined as an individual currently drinking alcoholic beverages in a daily amount of ≥ 80 g (male) or ≥ 40 g (female);

³TG13 severity assessment criteria for acute cholangitis (at admission);

⁴Reposition or additional insertion after initial PTBD insertion. PTBD: Percutaneous transhepatic biliary drainage; CCIs: Charlson comorbidity index score; WBC: White blood cell.

Table 2 Distribution of different microorganisms in positive bile cultures

Microorganism	n (%)
Enterococcus species	54 (24.4)
Escherichia coli	47 (21.3)
Pseudomonas species	27 (12.2)
Klebsiella species	26 (11.8)
Citrobacter species	18 (8.1)
Streptococcus species	12 (5.4)
Staphylococcus species	11 (5.0)
Enterobacter species	7 (3.2)
Proteus species	4 (1.8)
Stenotrophomonas maltophilia	4 (1.8)
Acinetobacter species	3 (1.4)
Aeromonas species	2 (< 1)
Morganella morganii	1 (< 1)
Corynebacterium species	1 (< 1)
Chromobacterium violaceum	1 (< 1)
Shewanella putrefaciens	1 (< 1)
Leuconostoc pseudomesenteroides	1 (< 1)
Candia albicans	1 (< 1)

Table 3 Univariate and multivariate analysis of risk factors for organ failure in patients with bacteriobilia who underwent percutaneous transhepatic biliary drainage because of acute cholangitis (n = 130) n (%)

Factor	Univariate analysis			Multivariate analysis
	Patients with OF (n = 22)	Patients without OF (n = 108)	P value	OR (95%CI)	P value
Age ≥ 65 yr	14 (63.6)	57 (52.8)	0.351
Male/female	11/11	64/44	0.423
Heavy smoker1	0 (0.0)	10 (9.3)	0.211
Heavy alcohol drinker2	1 (4.5)	6 (5.6)	1.000
Body temperature > 38 or < 36  °C	8 (36.4)	33 (30.6)	0.593
Positive Charcot’s triad	3 (13.6)	13 (12.0)	0.734
Symptom to door time (h)1	96.6 ± 88.8	99.4 ± 175.2	0.106
CCIs ≥ 4	10 (45.5)	65 (60.2)	0.202
Pre-existing renal dysfunction	7 (31.8)	4 (3.7)	0.0009	6.319 (1.348-29.629)	0.0199
Etiology
Choledocholithiasis	11 (50.0)	25 (23.1)	0.0109	3.573 (1.195-10.686)	0.0239
Benign biliary stricture	2 (9.1)	17 (15.7)	0.528
Malignant biliary obstruction	9 (40.9)	62 (57.4)	0.157
Procedure-related	0 (0.0)	4 (3.7)	1.000
Laboratory finding
WBC > 12000 or < 4000/mm3	13 (59.1)	44 (40.7)	0.114
Total bilirubin ≥ 5 mg/dL	10 (45.5)	32 (29.6)	0.148
ALP ≥ 250 IU/L	14 (63.6)	60 (55.6)	0.485
Albumin ≤ 2.8 g/dL	13 (59.1)	36 (33.3)	0.0239
C-reactive protein ≥ 5 mg/dL	16 (76.2)	74 (69.8)	0.557
The severity of acute cholangitis3
Mild	5 (22.7)	40 (37.0)	0.198
Moderate	7 (31.8)	41 (39.9)	0.586
Severe	10 (45.5)	27 (25.0)	0.053
Bile culture-Causative microorganism
Escherichia coli	4 (18.2)	15 (13.9)	0.740
Klebsiella species	2 (9.1)	7 (6.5)	0.648
Pseudomonas species	1 (4.5)	10 (9.3)	0.689
Enterobacter species	0 (0.0)	2 (1.9)	1.000
Enterococcus species	5 (22.7)	9 (8.3)	0.062
Other organism	2 (9.1)	9 (8.3)	1.000
Multiorganism	8 (36.4)	56 (51.8)	0.185
Bile culture-ESBL	3 (13.0)	11 (9.6)	0.705
Bile culture-MRSA	1 (4.3)	3 (2.6)	0.528
Bile culture-Antibiotic resistance4	10 (45.5)	52 (48.1)	0.818
Positive blood culture	8 (36.4)	36 (33.3)	0.784
Blood culture-Causative microorganism
Escherichia coli	5 (62.5)	18 (50.0)	0.542
Klebsiella species	1 (12.5)	9 (25.0)	1.000
Pseudomonas species	1 (12.5)	5 (13.9)	1.000
Other organism	0 (0.0)	3 (8.3)	1.000
Multiorganism	1 (12.5)	1 (2.8)	0.311
Blood culture-ESBL	3 (13.6)	2 (1.9)	0.0349	15.376 (1.748-135.267)	0.0149
Blood culture-Antibiotic resistance5	3 (13.6)	5 (4.6)	0.133
Same microorganisms6	4 (50.0)	16 (44.4)	0.747
Unsuccessful biliary decompression7	4 (18.2)	8 (7.4)	0.121
Visit to decompression time (h)8	21.6 ± 13.0	16.7 ± 11.3	0.103

¹ Heavy smoker is defined as an individual with 20 or more pack-years (1 pack year = 1 pack per day for one year) of use;

²Heavy drinker is defined as an individual currently drinking alcoholic beverages in a daily amount of ≥ 80 g (male) or ≥ 40 g (female);

³TG13 severity assessment criteria for acute cholangitis (at admission);

⁴Antibiotic susceptibility of microorganisms in bile culture;

⁵Initial antibiotic resistance of microorganisms in blood culture;

⁶The same microbial growth in bile cultures among patients with positive blood cultures;

⁷ Reposition or additional insertion after initial PTBD insertion;

⁸Values are presented as mean ± SD;

⁹Statistically significant. PTBD: Percutaneous transhepatic biliary drainage; OF: Organ failure; CCIs: Charlson comorbidity index score; WBC: White blood cell; ALP: Alkaline phosphatase; ESBL: Extended-spectrum beta-lactamase; OR: Odds ratio.