Predictive value of presepsin and acylcarnitines for severity and biliary drainage in acute cholangitis

doi:10.3748/wjg.v29.i16.2502

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World Journal of Gastroenterology

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World J Gastroenterol. Apr 28, 2023; 29(16): 2502-2514
Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2502

Table 1 Clinical characteristics according to severity grading of acute cholangitis

Variables	All cases (n = 280)	Mild (n = 65)	Moderate (n = 84)	Severe (n = 131)	P value
Demographic data, age (yr)	74 (66, 84)	69 (63, 81)	79.5 (69, 87)	74 (66, 84)	0.001
Male, n (%)	166 (59.3)	34 (52.3)	53 (63.1)	79 (60.3)	0.392
Comorbidities, n (%)
CHD	78 (27.9)	19 (29.2)	22 (26.2)	37(28.2)	0.911
Heart failure	23 (8.2)	3 (4.6)	5 (6.0)	15 (11.5)	0.173
Hypertension	87 (31.1)	16 (24.6)	32 (38.1)	39 (29.8)	0.192
CVD	33 (11.8)	4 (6.2)	10 (11.9)	19 (14.5)	0.233
COPD	10 (3.6)	1 (1.5)	2 (2.4)	7 (5.3)	0.313
Diabetes mellitus	64 (22.9)	11 (16.9)	18 (21.4)	35 (26.7)	0.286
Biliary drainage, n (%)					0.015
No	104 (37.1)	34 (52.3)	27 (32.1)	43 (35.0)
ERCP/PTCD	176 (62.9)	31 (47.7)	57 (67.9)	88 (67.2)
Infection data
Temperature (℃)	37.5 (36.7, 38.5)	37.2 (36.5, 38.0)	37.5 (36.6, 38.6)	37.8 (36.8, 38.5)	0.044
WBC count (× 10⁹/L)	10.73 (7.37, 14.83)	8.10 (6.47, 10.22)	13.00 (8.61, 16.56)	11.35 (7.89, 15.71)	< 0.001
Liver function
TBIL (μmol/L)	98.69 (62.63, 142.32)	69.26 (48.02, 103.37)	114.40 (77.04, 164.67)	103.99 (74.30, 139.53)	< 0.001
DBIL (μmol/L)	70.29 (42.68, 98.75)	43.20 (26.53, 75.64)	78.90 (58.09, 110.40)	72.07 (44.85, 96.29)	< 0.001
ALT (U/L)	148.00 (80.00, 287.50)	166.00 (63.50, 386.50)	145.00 (84.62, 300.00)	148.00 (77.00, 240.00)	0.626
AST (U/L)	138.05 (82.50, 286.10)	129.50 (69.60, 346.20)	138.80 (96.10, 299.10)	137.85 (72.03, 266.53)	0.744
SOFA score	2 (1, 4)	1 (1, 2)	1 (1, 2)	4 (3, 5)	< 0.001
28-d mortality, n (%)	9 (3.2)	0 (0.0)	0 (0.0)	9 (6.9)	0.005

Data expressed as median (P₂₅, P₇₅) or n (%). CHD: Coronary heart disease; CVD: Cerebral vascular disease; COPD: Chronic obstructive pulmonary disease; ERCP: Endoscopic retrograde cholangiopancreatography; PTCD: Percutaneous transhepatic biliary drainage; WBC: White blood cell; TBIL: Total bilirubin; DBIL: Direct bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; SOFA: Sequential organ failure assessment.

Table 2 Biomarkers according to severity grading of acute cholangitis

Biomarkers	All cases (n = 280)	Mild (n = 65)	Moderate (n = 84)	Severe (n = 131)	P value
Presepsin (pg/mL)	1864.00 (1169.75, 2765.75)	1053.00 (576.50, 1505.50)	1634.00 (1103.00, 2325.75)	2536.00 (1812.00, 3730.00)	< 0.001
Procalcitonin (ng/mL)	11.32 (2.10, 40.53)	3.57 (0.64, 10.87)	10.70 (1.48, 31.00)	27.43 (4.76, 54.32)	< 0.001
CRP (mg/L)	83.71 (44.23, 153.29)	48.02 (17.00, 103.48)	80.76 (48.39, 143.91)	107.00 (61.18, 174.12)	< 0.001
Acylcarnitines (μmol/L)
C0	28.54 (19.60, 38.65)	25.39 (18.72, 32.47)	29.65 (19.96, 38.38)	30.00 (21.19, 40.64)	0.042
C2	9.64 (6.16, 14.01)	8.35 (5.23, 12.29)	9.44 (6.67, 12.53)	10.32 (6.43, 15.30)	0.016
C3	0.38 (0.26, 0.60)	0.31 (0.21,0.43)	0.35 (0.26, 0.53)	0.46 (0.29, 0.71)	< 0.001
C4	0.09 (0.06, 0.16)	0.08 (0.06, 0.12)	0.09 (0.05, 0.13)	0.10 (0.07, 0.19)	0.003
C5	0.11 (0.07, 0.18)	0.08 (0.06, 0.18)	0.09 (0.06, 0.14)	0.14 (0.08, 0.24)	< 0.001
C6	0.11 (0.07,0.15)	0.08 (0.06, 0.14)	0.10 (0.06, 0.13)	0.13 (0.08, 0.20)	< 0.001
C8	0.13 (0.10, 0.22)	0.12 (0.08, 0.19)	0.13 (0.10, 0.20)	0.14 (0.11, 0.23)	0.037
C12	0.09 (0.04, 0.18)	0.14 (0.07, 0.28)	0.09 (0.04, 0.17)	0.08 (0.03, 0.13)	< 0.001
C12:1	0.05 (0.03, 0.08)	0.06 (0.04, 0.10)	0.05 (0.03, 0.09)	0.04 (0.02, 0.07)	0.001
C12DC	0.0005 (0.0004, 0.0008)	0.0006 (0.0005, 0.0009)	0.0005 (0.0004, 0.0009)	0.0004 (0.0003, 0.0007)	0.041
C13	0.03 (0.02, 0.07)	0.04 (0.03, 0.07)	0.03 (0.02, 0.08)	0.02 (0.01, 0.05)	0.008
C14	0.02 (0.01, 0.03)	0.03 (0.02, 0.04)	0.02 (0.01, 0.03)	0.02 (0.01, 0.03)	0.001
C14:1	0.09 (0.04, 0.16)	0.16 (0.07, 0.31)	0.09 (0.05, 0.13)	0.06 (0.03, 0.11)	< 0.001
C14:2	0.07 (0.03, 0.14)	0.12 (0.05, 0.22)	0.06 (0.03, 0.13)	0.05 (0.02, 0.10)	< 0.001
C16	0.10 (0.06, 0.15)	0.12 (0.08, 0.17)	0.10 (0.06, 0.14)	0.09 (0.05, 0.13)	0.003
C16:1	0.06 (0.03, 0.12)	0.10 (0.05, 0.16)	0.05 (0.03, 0.10)	0.05 (0.02, 0.12)	0.003
C16:2	0.02 (0.002, 0.06)	0.04 (0.01, 0.09)	0.01 (0.002, 0.05)	0.02 (0.002, 0.05)	0.006
C18:2	0.13 (0.07, 0.21)	0.16 (0.09, 0.24)	0.12 (0.07, 0.18)	0.11 (0.05, 0.22)	0.014
C18 OH	0.0004 (0.0002, 0.0009)	0.004 (0.003, 0.0013)	0.0006 (0.0002, 0.0010)	0.0004 (0.0002, 0.0007)	0.035
C20	0.0010 (0.0004, 0.0018)	0.0013 (0.0009, 0.0029)	0.0013 (0.0005, 0.0020)	0.0007 (0.0003, 0.0014)	0.001
C20:4	0.0013 (0.0007, 0.0023)	0.0018 (0.0009, 0.0021)	0.0018 (0.0008, 0.0037)	0.0012 (0.0005, 0.0020)	0.024
C22	0.0009 (0.0003, 0.0015)	0.0011 (0.0006, 0.0023)	0.0010 (0.0003, 0.0018)	0.0006 (0.0002, 0.0014)	0.009

Data expressed as median (P₂₅, P₇₅). CRP: C-reactive protein; C0: DL-Carnitine; C2: Acetyl-L-carnitine; C3: Propionyl-L-carnitine; C4: Butyryl-L-carnitine; C5: Valeryl-L-carnitine; C6: Hexenoyl-L-carnitine; C8: Octanoyl-L-carnitine; C12: Dodecanoyl-L-carnitine; C12:1: Dodecenoyl-L-carnitine; C12DC: Dodecanedioyl-L-carnitine; C13: Tridecanoyl-L-carnitine; C14: Tetradecanoyl-L-carnitine; C14:1: Tetradecenoyl-L-carnitine; C14:2: Tetradecadienyl-L-carnitine; C16: Hexadecanoyl-L-carnitine; C16:1: Hexadecenoyl-L-carnitine; C16:2: Hexadecadienyl-L-carnitine; C18:2: Octadecadienyl-L-carnitine; C18OH: Hydroxyoctadecanoyl-L-carnitine; C20: Icosyl-L-carnitine; C20:4: Arachidonoyl-L-carnitine; C22: Behenoyl-L-carnitine.

Table 3 Clinical variables and biomarkers associated with severity of acute cholangitis (multivariate logistic regression models)

	Mild vs moderate/severe		Mild/moderate vs severe
Variables	OR (95%CI)	P value	OR (95%CI)	P value
Presepsin (pg/mL)	1.001 (1.000-1.002)	< 0.001	1.000 (1.000-1.001)	< 0.001
Procalcitonin (ng/mL)	1.018 (0.995-1.041)	0.134	1.021 (1.008-1.035)	0.001
WBC (× 10⁹/L)	1.149 (1.050-1.258)	0.003	0.990 (0.945-1.037)	0.676
CRP (mg/L)	1.001 (0.995-1.008)	0.642	1.003 (0.999-1.008)	0.104
TBIL(μmol/L)	1.008 (1.003-1.013)	0.003	0.999 (0.996-1.002)	0.504
Temperature (℃)	1.540 (1.046-2.267)	0.029	1.118 (0.859-1.456)	0.407
Age (yr)	1.051 (1.018-1.085)	0.002	1.000 (0.977-1.022)	0.973
C14:2 (μmol/L)	0.036 (0.002-0.663)	0.025	-	-
C5 (μmol/L)	-	-	11.490(2.213-59.656)	0.004

WBC: White blood cell; CRP: C-reactive protein; TBIL: Total bilirubin; C14:2: Tetradecadienyl-L-carnitine; C5: Valeryl-L-carnitine; OR: Odds ratio; CI: Confidence interval.

Table 4 A model for predicting biliary drainage in acute cholangitis multivariate logistic regression models

Variables	B	SE	Wald	df	OR	95%CI	P value	Score
Presepsin > 1868 (pg/mL)	0.838	0.291	8.308	1	2.312	1.308-4.087	0.004	1
C4 ≤ 0.1803 (μmol/L)	1.202	0.347	12.017	1	3.326	1.686-6.561	0.001	1
DBIL > 51.18 (μmol/L)	0.643	0.290	4.912	1	1.902	1.077-3.358	0.027	1
ALT > 159 (U/L)	0.630	0.275	5.254	1	1.878	1.096-3.219	0.022	1
Temperature ≥ 37.3 (℃)	0.746	0.270	7.602	1	2.108	1.241-3.581	0.006	1

C4: Butyryl-L-carnitine; DBIL: Direct bilirubin; ALT: Alanine aminotransferase; OR: Odds ratio; CI: Confidence interval.

Table 5 Variables associated with bloodstream infection multivariate logistic regression models

Variables	B	SE	Wald	df	OR	95%CI	P value
Presepsin (High vs low¹)	1.243	0.524	5.617	1	3.466	1.240-9.689	0.018
Procalcitonin (High vs low²)	1.400	0.401	12.208	1	4.054	1.849-8.889	< 0.001
C2 (High vs low³)	1.313	0.464	7.998	1	3.716	1.496-9.229	0.005
C3 (High vs low⁴)	0.319	0.400	0.636	1	1.376	0.628-3.015	0.425
C6 (High vs low⁵)	-0.450	0.436	1.065	1	0.638	0.271-1.499	0.302
C12:1 OH (High vs low⁶)	1.284	0.410	9.829	1	3.611	1.618-8.058	0.002
Sex	0.282	0.356	0.628	1	1.326	0.660-2.667	0.428
Temperature (℃)	0.513	0.174	8.714	1	1.671	1.188-2.350	0.003
Severity grading	-0.071	0.285	0.062	1	0.932	0.533-1.628	0.804
SOFA score	-0.062	0.081	0.587	1	0.940	0.802-1.101	0.444

¹Presepsin (high vs low): > 1147.5 pg/mL vs ≤ 1147.5 pg/mL.

²Procalcitonin (high vs low): > 10.83 ng/mL vs ≤ 10.83 ng/mL.

³C2 (high vs low): > 14.59 μmol/L vs ≤ 14.59 μmol/L.

⁴C3 (high vs low): > 0.53 μmol/L vs ≤ 0.53 μmol/L.

⁵C6 (high vs low): > 0.12 μmol/L vs ≤ 0.12 μmol/L.

⁶C12:1 OH (high vs low): > 0.02 μmol/L vs ≤ 0.02 μmol/L.

C2: Acetyl-L-carnitine; C3: Propionyl-L-carnitine; C6: Hexanoyl-L-carnitine; C12:1 OH: Hydroxydodecenoyl-L-carnitine; SOFA: Sequential organ failure assessment; OR: Odds ratio; CI: Confidence interval.

Citation: Zhang HY, Xiao HL, Wang GX, Lu ZQ, Xie MR, Li CS. Predictive value of presepsin and acylcarnitines for severity and biliary drainage in acute cholangitis. World J Gastroenterol 2023; 29(16): 2502-2514
URL: https://www.wjgnet.com/1007-9327/full/v29/i16/2502.htm
DOI: https://dx.doi.org/10.3748/wjg.v29.i16.2502