Reduction of serum bilirubin levels after endoscopic biliary drainage in patients with extrahepatic biliary obstruction and its significance

Table 1 Baseline characteristics of the patients included in the present study, n (%)/median (interquartile range)

Parameters	Total (n = 101)	Benign (n = 40)	Malignant (n = 61)	P value
Age, years	56 (22-92)	50 (22-79)	58 (26-92)	0.008
Male gender	55 (54.5)	23 (57.5)	32 (52.5)	0.618
Comorbidities	27 (26.7)	12 (30)	15 (24.6)	0.548
Diabetes mellitus	15 (14.8)	8 (20)	7 (11.5)
Hypertension	2 (2.0)	1 (2.5)	1 (1.6)
DM + hypertension	5 (4.9)	1 (2.5)	4 (6.5)
Others	5 (4.9)	2 (5)	3 (4.9)
Cholangitis	52 (51.5)	23 (57.5)	29 (47.5)	0.327
Leucocyte count, × 103 per mm3	10.35 (4.69-44.0)	10.23 (5.6-34.1)	10.74 (4.69-44.0)	0.843
PT-INR	1.2 (0.9-4.1)	1.2 (1.0-3.2)	1.3 (0.9-4.1)	0.044
Serum creatinine, mg/dL	0.7 (0.4-5.7)	0.8 (0.4-5.7)	0.6 (0.4-2.9)	0.069
Total bilirubin level, mg/dL	11.8 (6.0-30.2)	9.9 (6.0-24.7)	13.5 (6.1-30.2)	0.008
Alkaline phosphatase, IU/L	368 (109-2000)	360 (119-1500)	372 (109-2000)	0.034
Plastic stent	94 (93.1)	40 (100)	54 (88.5)	0.040

DM: Diabetes mellitus; PT: Prothrombin time; INR: International normalized ratio.

Table 2 Association between type of etiology and baseline bilirubin levels with the time to achieve total bilirubin < 3 mg/dL (n = 101), n (%)

Groups	Within 1 day	Within 2 days	Within 7 days	Within 15 days	Within 30 days	Total
Total	1 (0.9)	6 (5.9)	36 (35.6)	70 (69.3)	86 (85.1)	101
Etiology of EHBO
Benign	1 (2.5)	6 (15.0)1	23 (57.5)1	33 (82.5)1	38 (95.0)1	40
Malignant	0 (0.0)	0 (0.0)	13 (21.3)	37 (60.6)	48 (78.7)	61
Bilirubin level
≤ 10 mg/dL	2 (5.6)	9 (25.0)1	26 (72.2)1	33 (91.7)1	35 (97.2)1	36
> 10 mg/dL	0 (0.0)	0 (0.0)	10 (15.4)	37 (56.9)	52 (80.0)	65

¹Statistically significant difference.

EHBO: Extrahepatic biliary obstruction.

Table 3 Multivariate analysis of the predictors of > 50% reduction in total bilirubin by day 7 and total bilirubin < 3 mg/dL by day 15

Variables	> 50% in bilirubin by day 7		Bilirubin < 3 mg/dL by day 15
	Odds ratio (95%CI)	P value	Odds ratio (95%CI)	P value
Age	0.952 (0.910-0.995)	0.03	0.989 (0.939-1.043)	0.689
Female gender	0.723 (0.236-2.215)	0.571	0.622 (0.145-2.664)	0.522
No cholangitis at baseline	0.639 (0.210-2.029)	0.447	4.944 (0.857-28.524)	0.074
Benign etiology	4.303 (1.085-17.059)	0.038	1.226 (0.239-6.303)	0.807
Baseline total bilirubin	0.935 (0.849-1.030)	0.175	0.79 (0.72-0.89)	< 0.001
ALP	1.002 (1.000-1.004)	0.066	1.002 (1.000-1.003)	0.043

CI: Confidence intervals; ALP: Alkaline phosphatase.

Table 4 Multivariate analysis to assess the impact of bilirubin dynamics on reintervention

Variables	Model 1 (> 50% in bilirubin by day 7)		Model 2 (bilirubin < 3 mg/dL by day 15)
	Odds ratio (95%CI)	P value	Odds ratio (95%CI)	P value
All patients
Benign etiology	0.235 (0.024-2.348)	0.218	0.200 (0.021-1.880)	0.159
No cholangitis at baseline	4.528 (0.966-21.235)	0.055	5.258 (1.091-25.348)	0.039
Baseline bilirubin < 10 mg/dL	1.467 (0.286-7.513)	0.646	2.512 (0.422-14.955)	0.312
Failure to achieve > 50% in bilirubin by day 7	4.751 (1.035-21.086)	0.045	-	-
Failure to achieve bilirubin < 3 mg/dL by day 15	-	-	4.411 (0.795-24.475)	0.090
Malignant etiology
No cholangitis at baseline	3.555 (0.689-18.333)	0.130	4.039 (0.780-20.901)	0.096
Baseline bilirubin < 10 mg/dL	1.085 (0.173-6.807)	0.930	1.813 (0.262-12.554)	0.547
Failure to achieve > 50% in bilirubin by day 7	5.473 (1.089-27.498)	0.039	-	-
Failure to achieve bilirubin < 3 mg/dL by day 15	-	-	4.406 (0.776-25.030)	0.094

CI: Confidence intervals.

Table 5 Multivariate analysis to assess the predictors of 3-month mortality

Variables	Model 1 (> 50% in bilirubin by day 7)		Model 2 (Bilirubin < 3 mg/dL by day 15)
	Odds ratio (95%CI)	P value	Odds ratio (95%CI)	P value
All patients
Age	1.013 (0.967-1.062)	0.582	1.011 (0.964-1.060)	0.654
Benign etiology	0.116 (0.013-1.015)	0.052	0.128 (0.014-1.127)	0.064
No AKI at baseline	0.136 (0.031-0.601)	0.009	0.194 (0.041-0.927)	0.040
Failure to achieve > 50% in bilirubin by day 7	2.075 (0.522-8.254)	0.300	-	-
Failure to achieve bilirubin < 3 mg/dL by day 15	-	-	5.396 (1.370-21.254)	0.016
Malignant etiology
Age	1.024 (0.971-1.079)	0.385	1.017 (0.965-1.072)	0.530
No AKI at baseline	0.103 (0.020-0.541)	0.007	0.154 (0.027-0.886)	0.036
Failure to achieve > 50% in bilirubin by day 7	1.965 (0.457-8.455)	0.364	-	-
Failure to achieve bilirubin < 3 mg/dL by day 15	-	-	6.915 (1.496-31.963)	0.013

CI: Confidence intervals; AKI: Acute kidney injury.