Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis

doi:10.4254/wjh.v13.i4.456

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World Journal of Hepatology

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Retrospective Cohort Study

World J Hepatol. Apr 27, 2021; 13(4): 456-471
Published online Apr 27, 2021. doi: 10.4254/wjh.v13.i4.456

Table 1 Patient demographics and clinical profile

	Overall cohort, n = 457				PSM cohort, n = 224
	Elderly, n = 318	Non-elderly, n = 139	P value	SMD	Elderly, n = 112	Non-elderly, n = 112	P value	SMD
Age, yr	84.0 (82.1, 86.6)	67.9 (57.1, 77.2)	< 0.001		84.3 (82.1, 87.3)	66.6 (55.6, 76.4)	< 0.001
Gender¹, male (%)	132 (41.5)	73 (52.5)	0.029	0.221	57 (50.9)	53 (47.3)	0.593	0.071
Co-morbidities, n (%)
Diabetes mellitus	124 (39)	55 (39.6)	0.908		44 (39.3)	47 (42)	0.683
Ischemic heart disease¹	87 (27.4)	27 (19.4)	0.071	0.188	22 (19.6)	23 (20.5)	0.868	0.022
Chronic renal impairment¹	61 (19.2)	17 (12.2)	0.069	0.191	17 (15.2)	14 (12.5)	0.562	0.077
COPD and/or asthma	18 (5.7)	4 (2.9)	0.201		8 (7.1)	3 (2.7)	0.122
History of biliary disease¹	182 (57.2)	58 (41.7)	0.002	0.313	50 (44.6)	53 (47.3)	0.688	0.054
Clinical presentation
Abdominal pain¹	197 (61.9)	109 (78.4)	0.001	0.365	85 (75.9)	85 (75.9)	1.000	< 0.001
Fever¹	141 (44.3)	67 (48.2)	0.446	0.077	50 (44.6)	52 (46.4)	0.788	0.036
Vomiting	142 (44.7)	63 (45.3)	0.895		51 (45.5)	50 (44.6)	0.893
Jaundice¹	48 (15.1)	38 (27.3)	0.002	0.302	27 (24.1)	23 (20.5)	0.521	0.085
Hypotension¹^,²	18 (5.7)	12 (8.6)	0.238	0.115	10 (8.9)	6 (5.4)	0.299	0.138
Laboratory investigations
WBC¹(10⁹/L)	12.4 (8.9, 16.1)	12.1 (8.3, 15.9)	0.551	0.113	12.2 (8.6, 15.4)	12.1 (8.0, 16.2)	0.745	0.100
Platelets¹(10⁹/L)	192 (150, 250)	216 (166, 280)	0.047	0.131	193 (160, 252)	209 (162, 280)	0.308	0.101
Creatinine¹ (μmol/L)	103 (81, 138)	89 (68, 116)	< 0.001	0.094	103 (80, 136)	86 (67, 119)	0.003	0.088
Albumin¹ (g/L)	32 (28, 35)	35 (29, 38)	< 0.001	0.396	33 (29, 36)	34 (29, 38)	0.186	0.150
Bilirubin¹(μmol/L)	54 (33, 84)	60 (34, 96)	0.226	0.096	65 (42, 93)	58 (33, 93)	0.287	0.104
ALT (IU/L)	133 (61, 247)	143 (68, 295)	0.330		142 (82, 244)	123 (59, 263)	0.294
AST (IU/L)	160 (78, 366)	140 (72, 314)	0.165		176 (93, 365)	150 (74, 345)	0.149
ALP (IU/L)	209 (130, 346)	188 (117, 314)	0.149		208 (137, 346)	184 (111, 291)	0.136
GGT¹(IU/L)	242 (129, 435)	327 (158, 562)	0.006	0.292	286 (165, 504)	286 (133, 523)	0.591	0.022
INR¹	1.13 (1.02, 1.30)	1.20 (1.10, 1.30)	0.890	0.112	1.15 (1.00, 1.30)	1.20 (1.10, 1.30)	0.506	0.038
Microbiology, positive (%)	132 (41.5)	48 (34.5)	0.160		44 (39.3)	36 (32.1)	0.265
Escherichia coli	99 (75)	30 (62.5)	0.100		33 (75)	24 (66.7)	0.413
Klebsiella pneumoniae	32 (24.2)	14 (29.2)	0.503		16 (36.4)	12 (33.3)	0.777
Enterobacter spp	3 (2.3)	1 (2.1)	0.939		0 (0)	1 (2.8)	0.266
Pseudomonas aeruginosa	1 (0.8)	0 (0)	0.550		0 (0)	0 (0)	-
Enterococcus spp	1 (0.8)	1 (2.1)	0.453		1 (2.3)	1 (2.8)	0.886
Citrobacter spp	1 (0.8)	0 (0)	0.545		1 (2.3)	0 (0)	0.357
Aeromonas spp	1 (0.8)	0 (0)	0.545		0 (0)	0 (0)	-
CT scan, n (%)	108 (34)	52 (37.4)	0.477		43 (38.4)	45 (40.2)	0.784
Cholelithiasis	75 (69.4)	31 (59.6)	0.218		21 (48.8)	14 (31.1)	0.089
Biliary dilation	47 (43.5)	18 (34.6)	0.283		30 (69.8)	26 (57.8)	0.243
Choledocholithiasis	63 (58.3)	18 (34.6)	0.005		27 (62.8)	14 (31.1)	0.003
MRCP, n (%)	157 (49.4)	73 (52.5)	0.536		61 (54.5)	55 (49.1)	0.422
Cholelithiasis	113 (72)	38 (52.1)	0.003		37 (60.7)	35 (63.6)	0.741
Biliary dilation	93 (59.2)	50 (68.5)	0.178		41 (67.2)	26 (47.3)	0.030
Choledocholithiasis	103 (65.6)	39 (53.4)	0.077		41 (67.2)	23 (41.8)	0.006
Shock Index, abnormal³	194 (61)	88 (63.3)	0.641		66 (58.9)	73 (65.2)	0.335
TG13 severity grading	2 (2, 3)	2 (1, 2)	< 0.001		2 (1, 3)	2 (1, 2)	0.016
Grade I	67 (21.1)	66 (47.5)			31 (27.7)	46 (41.1)
Grade II	152 (47.8)	46 (33.1)			49 (43.8)	46 (41.1)
Grade III	99 (31.1)	27 (19.4)			32 (28.6)	20 (17.9)

All continuous variables were expressed as median (interquartile range) unless specified. All categorical variables were expressed as n (%) unless otherwise specified.

¹Propensity score matching was performed for these variables due to potential and/or significant effects on clinical outcomes, or due to significant differences in demographics between the two study groups.

²Hypotension was defined as systolic blood pressure of < 90 mmHg.

³Shock index was defined as heart rate divided by the respective systolic blood pressure during triage, where the normal range is 0.5 to 0.7 (inclusive). ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; AST: Aspartate aminotransferase; COPD: Chronic obstructive pulmonary disease; CT: Computed tomography; GGT: Gamma-glutamyl transferase; INR: International normalized ratio; MRCP: Magnetic resonance cholangiopancreatography; PSM: Propensity score matching; SMD: Standardized mean difference; TG13: Tokyo Guidelines 2013; WBC: White blood cell.

Table 2 Clinical outcomes between elderly vs non-elderly patients

	Overall cohort, n = 457				PSM cohort, n = 224
	Elderly, n = 318	Non-elderly, n = 139	OR, 95%CI	P value	Elderly, n = 112	Non-elderly, n = 112	OR, 95%CI	P value
Initial management
ERCP	206 (64.8)	86 (61.9)	1.13 (0.75, 1.71)	0.551	77 (68.8)	65 (58)	1.59 (0.02, 2.75)	0.096
Percutaneous transhepatic biliary drainage	25 (7.9)	6 (4.3)	1.89 (0.76, 4.72)	0.166	13 (11.6)	5 (4.5)	2.81 (0.97, 8.17)	0.049
Conservative	98 (30.8)	49 (35.3)	0.82 (0.54, 1.25)	0.351	29 (25.9)	43 (38.4)	0.56 (0.32, 0.99)	0.045
Subsequent management
Index admission cholecystectomy	16 (5.0)	13 (9.4)	0.51 (0.24, 1.10)	0.081	2 (1.8)	12 (10.7)	0.15 (0.03, 0.69)	0.006
Interval cholecystectomy	20 (6.3)	11 (7.9)	0.78 (0.36, 1.68)	0.525	7 (6.3)	10 (8.9)	0.68 (0.25, 1.86)	0.449
Length of hospital stay, days	8 (6, 13)	8 (5, 11)	-	0.040	7.5 (5, 11)	8 (5, 11)	-	0.982
In-hospital mortality	16 (5.0)	5 (3.6)	1.42 (0.51, 3.96)	0.500	6 (5.4)	5 (4.5)	1.21 (0.36, 4.09)	0.757
30-d mortality	27 (8.5)	7 (5)	1.75 (0.74, 4.12)	0.195	8 (7.1)	7 (6.3)	1.15 (0.40, 3.30)	0.789
90-d mortality	31 (9.7)	8 (5.8)	1.77 (0.79, 3.95)	0.160	8 (7.1)	8 (7.1)	1.00 (0.36, 2.77)	1.000

All continuous variables were expressed as median (interquartile range) unless specified. All categorical variables were expressed as n (%) unless otherwise specified. ERCP: Endoscopic retrograde cholangiopancreatography; CI: Confidence interval; OR: Odds ratio; PSM: Propensity score matching.

Table 3 Subgroup analysis of patients who had endoscopic retrograde cholangiopancreatography on outcomes in elderly vs and non-elderly patients

	Overall cohort, n = 292				PSM cohort, n = 142
	Elderly, n = 206	Non-elderly, n = 86	OR, 95%CI	P value	Elderly, n = 77	Non-elderly, n = 65	OR, 95%CI	P value
Timing of ERCP from presentation				0.012			-	0.247
Within 24 h	15 (7.3)	16 (18.6)			9 (11.7)	12 (18.5)
24-48 h	36 (17.5)	13 (15.1)			14 (18.2)	11 (16.9)
48-72 h	34 (16.5)	19 (22.1)			12 (15.6)	16 (24.6)
>72 h	121 (58.7)	38 (44.2)			42 (54.6)	26 (40)
Stone(s) removed	102 (49.5)	44 (51.2)	0.94 (0.57, 1.55)	0.797	36 (46.8)	30 (46.2)	1.02 (0.53, 1.99)	0.943
Stent placed	89 (43.2)	38 (44.2)	0.96 (0.58, 1.60)	0.877	35 (45.5)	30 (46.2)	0.97 (0.50, 1.89)	0.934
Length of hospital stay, d	9 (7, 13)	8 (5, 11)	-	0.016	8 (5, 12)	8 (5, 12)	-	0.546
In-hospital mortality	2 (1)	1 (1.2)	0.83 (0.08, 9.31)	0.882	1 (1.3)	1 (1.5)	0.84 (0.05, 13.73)	0.904
30-d mortality	13 (6.3)	4 (4.7)	1.38 (0.44, 4.36)	0.581	3 (3.9)	4 (6.2)	0.62 (0.13, 2.87)	0.536
90-d mortality	16 (7.8)	4 (4.7)	1.73 (0.56, 5.32)	0.337	3 (3.9)	4 (6.2)	0.62 (0.13, 2.87)	0.536

Table 4 Subgroup analysis of patients who had abnormal shock index on triage on outcomes in elderly vs non-elderly patients

	Overall cohort, n = 282				PSM cohort, n = 139
	Elderly, n = 194	Non-elderly, n = 88	OR, 95%CI	P value	Elderly, n = 66	Non-elderly, n = 73	OR, 95%CI	P value
Length of hospital stay, d	8 (6-13)	8 (6-10.8)		0.379	8 (5-12)	6 (5-10)		0.217
In-hospital mortality	10 (5.2)	3 (3.4)	1.54 (0.41, 5.74)	0.517	3 (4.5)	3 (4.1)	1.11 (0.22, 5.71)	0.900
30-d mortality	19 (9.8)	4 (4.5)	2.28 (0.75, 6.91)	0.136	5 (7.6)	4 (5.5)	1.41 (0.36, 5.50)	0.616
90-d mortality	20 (10.3)	5 (5.7)	1.91 (0.62, 5.26)	0.205	5 (7.6)	5 (6.8)	1.12 (0.31, 4.04)	0.869

All continuous variables were expressed as median (interquartile range) unless specified. All categorical variables were expressed as n (%) unless otherwise specified. CI: Confidence interval; OR: Odds ratio; PSM: Propensity score matching.

Citation: Chan KS, Mohan R, Low JK, Junnarkar SP, Huey CWT, Shelat VG. Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis. World J Hepatol 2021; 13(4): 456-471
URL: https://www.wjgnet.com/1948-5182/full/v13/i4/456.htm
DOI: https://dx.doi.org/10.4254/wjh.v13.i4.456