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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk factors of organ failure in cholangitis with bacteriobilia
Jae Min Lee, Sang Hyub Lee, Kwang Hyun Chung, Jin Myung Park, Ban Seok Lee, Woo Hyun Paik, Joo Kyung Park, Ji Kon Ryu, Yong-Tae Kim
Jae Min Lee, Sang Hyub Lee, Kwang Hyun Chung, Ban Seok Lee, Ji Kon Ryu, Yong-Tae Kim, Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744, South Korea
Jae Min Lee, Department of Internal Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 660-702, South Korea
Jin Myung Park, Department of Internal Medicine, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon 033-258, South Korea
Woo Hyun Paik, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang 633-165, South Korea
Joo Kyung Park, Department of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
Author contributions: Lee JM acquired, analyzed and interpreted the data, and drafted the article; Lee SH conceived, designed and supervised the study; Chung KH and Park JM acquired the data; Lee BS performed the statistical analysis; Paik WH and Park JK analyzed and interpreted the data; Ryu JK and Kim YT critically revised the article for important intellectual content; All authors read and approved the final manuscript. All authors had full access to all of the data (including statistical reports and tables) and take responsibility for the integrity of the data and the accuracy of the data analysis.
Ethics approval: The study was reviewed and approved by the Institutional Review Board of Seoul National University Hospital (IRB No. H-1308-086-514).
Informed consent: Not applicable (due to the retrospective study using information contained in medical charts and computerized records).
Conflict-of-interest: No conflict-of-interest exists for any of the authors.
Data sharing: The technical appendix, statistical code, and dataset are available from the corresponding author at [gidoctor@snuh.org]. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sang Hyub Lee, MD, PhD, Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea.
gidoctor@snuh.org
Telephone: +82-2-20724892 Fax: +82-2-7629662
Received: December 15, 2014
Peer-review started: December 16, 2014
First decision: February 10, 2015
Revised: February 20, 2015
Accepted: March 30, 2015
Article in press: March 31, 2015
Published online: June 28, 2015
Processing time: 195 Days and 19.5 Hours
AIM: To identify the risk factors for organ failure (OF) in cholangitis with bacteriobilia.
METHODS: This study included 182 patients with acute cholangitis who underwent percutaneous transhepatic biliary drainage between January 2005 and April 2013. We conducted a retrospective analysis of comprehensive clinical and laboratory data.
RESULTS: There were 24 cases (13.2%) of OF and five deaths (2.7%). Bile culture was positive for microbial growth in 130 out of 138 (94.2%) patients. In multivariate analysis of 130 patients with positive bile cultures, significant predictive factors for OF were the presence of extended-spectrum beta-lactamase (ESBL) organisms in blood cultures, pre-existing renal dysfunction, and choledocholithiasis as an etiology, with odds ratios of 15.376, 6.319, and 3.573, respectively. We developed a scoring system with a regression coefficient of each significant variable. The OF score was calculated using the following equation: (2.7 × ESBL organisms in blood cultures) + (1.8 × pre-existing renal dysfunction) + (1.3 × choledocholithiasis). This scoring system for predicting OF was highly specific (99.1%) and had a positive predictive value of 86.2%.
CONCLUSION: ESBL organisms in blood cultures, pre-existing renal dysfunction, and choledocholithiasis are risk factors for OF in cholangitis with bacteriobilia. The OF scoring system may aid clinicians to identify a poor prognosis group.
Core tip: There has been no study of the prognostic factors in acute cholangitis with bacteriobilia. The current study identified three risk factors for organ failure in cholangitis with bacteriobilia: extended-spectrum beta-lactamase organisms in blood cultures, pre-existing renal dysfunction, and choledocholithiasis as an etiology. In addition, a organ failure scoring system created by these risk factors may aid clinicians to identify a poor prognosis group.
