Observational Study
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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
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
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
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
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
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