Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.6984
Peer-review started: August 13, 2023
First decision: August 24, 2023
Revised: September 2, 2023
Accepted: September 26, 2023
Article in press: September 26, 2023
Published online: October 16, 2023
Processing time: 61 Days and 0.4 Hours
Whether the clinical outcome of acute cholangitis (AC) differs depending on the cause is unknown.
This study aimed to elucidate whether the clinical manifestations and outcomes of AC caused by malignant biliary obstruction (MBO) and choledocholithiasis differ.
The primary outcome comparison was 30-d mortality. The secondary outcome comparisons were intensive care unit admission rate, length of hospital stay, and 30-d readmission rate.
This retrospective study included 516 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) due to AC caused by MBO (MBO group, n = 56) and common bile duct stones (CBDS group, n = 460). Clinical and laboratory parameters were compared between the groups. Propensity score matching (PSM) created 55 matched pairs. Confounders used in the PSM analysis were age, sex, time to ERCP, and technical success of ERCP. The primary outcome comparison was 30-d mortality. The secondary outcome comparisons were intensive care unit admission rate, length of hospital stay, and 30-d readmission rate.
The 30-d mortality, intensive care unit admission rates, 30-d readmission rates, and length of hospital stay were significantly higher or longer in the MBO group. However, only the length of hospital stay remained significant in the propensity score matching analysis. Multivariate analysis revealed that time-to-ERCP and multiple organ dysfunction were independent factors associated with 30-d mortality.
MBO patients undergo ERCP later, and the prognosis is worse than that of patients with choledocholithiasis. Therefore, newly diagnosed MBO patients with clinically suspected AC should be alerted and ERCP should be performed as soon as possible for biliary drainage.
The diagnostic criteria used for systemic inflammation may differ between patients with MBO and those with choledocholithiasis, and this may be considered in the development of new guidelines in the future.