Brief Article
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World J Gastrointest Endosc. Mar 16, 2014; 6(3): 74-81
Published online Mar 16, 2014. doi: 10.4253/wjge.v6.i3.74
Factors predicting adverse short-term outcomes in patients with acute cholangitis undergoing ERCP: A single center experience
Udayakumar Navaneethan, Norma G Gutierrez, Ramprasad Jegadeesan, Preethi GK Venkatesh, Madhusudhan R Sanaka, John J Vargo, Mansour A Parsi
Udayakumar Navaneethan, Norma G Gutierrez, Ramprasad Jegadeesan, Preethi GK Venkatesh, Madhusudhan R Sanaka, John J Vargo, Mansour A Parsi, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Navaneethan U contributed to study concept and design, paper preparation and critical revisions; Gutierrez N, Jegadeesan R and Venkatesh PGK contributed to data monitoring and paper preparation; Sanaka M, Vargo J and Parsi M contributed to study concept, design, and critical revisions.
Supported by The American College of Gastroenterology Grant to Navaneethan U
Correspondence to: Mansour A Parsi, MD, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, United States. parsim@ccf.org
Telephone: +1-216-5020981 Fax: +1-216-4446305
Received: July 31, 2013
Revised: October 10, 2013
Accepted: November 12, 2013
Published online: March 16, 2014
Processing time: 8 Days and 20.4 Hours
Abstract

AIM: To identify potential factors that can predict adverse short-term outcomes in patients with acute cholangitis undergoing endoscopic retrograde cholangiopancreatography (ERCP).

METHODS: Retrospective analysis of consecutive patients admitted to our center for acute cholangitis and underwent ERCP from 2001 to 2012. Involvement of two or more organ systems was termed as organ failure (OF). Cardiovascular failure was defined based on a systolic blood pressure of < 90 mmHg despite fluid replacement and/or requiring vasopressor treatment; respiratory failure if the Pa02/Fi02 ratio was < 300 mmHg and/or required mechanical ventilation; coagulopathy if the platelet count was < 80; and renal insufficiency if serum creatinine was > 1.9 mg/dL. Variables associated with short term adverse clinical outcomes defined as persistent OF and/or 30-d mortality was determined.

RESULTS: A total of 172 patients (median age 62 years, 56.4% female) were included. The median door to ERCP time was 17 h. Bile duct stones were the most common etiology (n = 67, 39.2%). In multivariate analysis, factors that were independently associated with persistent OF and/or 30-d mortality included American Society of Anesthesiology (ASA) physical classification score > 3 (OR = 7.70; 95%CI: 2.73-24.40), presence of systemic inflammatory response syndrome (OR = 3.67; 95%CI: 1.34-10.3) and door to ERCP time greater than 72 h (OR = 3.36; 95%CI: 1.12-10.20). Door to ERCP time greater than 72 h was also associated with 70% increase in the mean length of stay (P < 0.001). Every one point increase in the ASA physical classification and every 1 mg/dL increase in the pre-ERCP bilirubin level was associated with a 34% and 2% increase in the mean length of hospital stay, respectively. Transfer status did not impact clinical outcomes.

CONCLUSION: Higher ASA physical classification and delays in ERCP are associated with adverse clinical outcomes and prolonged length of hospital stay in patients with acute cholangitis undergoing ERCP.

Keywords: Endoscopic retrograde cholangiopancreatography; Cholangitis; Outcomes

Core tip: We investigated the effect of timing of endoscopic retrograde cholangiopancreatography (ERCP) on clinical outcomes defined as persistent organ failure and/or 30-d mortality, and length of hospital stay in patients with acute cholangitis. We observed that an American Society of Anesthesiology physical classification score > 3, presence of systemic inflammatory response syndrome and door to ERCP time greater than 72 h are associated with adverse clinical outcomes and prolonged length of hospital stay in patients with acute cholangitis.