Factors predicting adverse short-term outcomes in patients with acute cholangitis undergoing ERCP: A single center experience

Table 1 Characteristics of study population and endoscopic retrograde cholangiopancreatography procedures n (%)

Variable	Value
Age (yr)	61.0 ± 16.9
Male	97 (56.4)
Race (white)	135 (80.8)
BMI (kg/m2)	26.9 ± 5.9
Smokers	45 (37.5)
Alcohol consumption	19 (12.8)
With primary sclerosing cholangitis	48 (27.9)
With fever	105 (61.8)
With SIRS	33 (19.5)
Transfer patients	64 (37.4)
Patients admitted to gastroenterology service	111 (64.5)
Patients with post-liver transplantation	4 (2.3)
Charlson comorbidity index
0	33 (19.4)
1	37 (21.8)
2	23 (13.5)
3	43 (25.3)
> 4	34 (20.0)
American Society of Anesthesiology Physical Classification
1	2 (1.2)
2	2 (1.2)
3	101 (59.1)
4	62 (36.3)
5	4 (2.3)
Altered mental status	8 (4.7)
Medications at admission
Antibiotics	126 (76.4)
Anti-platelets (aspirin and/or clopidogrel)	37 (22.3)
Statins	31 (18.7)
Etiology of cholangitis:
Choledocholithiasis	67 (38.9)
Primary sclerosing cholangitis	45 (26.2)
Malignant stricture	28 (16.3)
Benign stricture	20 (11.6)
Others	12 (6.9)
Laboratory values:
Pre-procedural bilirubin (mg/dL)	6.0 ± 5.0
Pre-procedural platelet count (cells/cu.mm)	189.4 ± 117.3
Pre-procedural international normalized ratio	1.2 ± 0.5
Serum creatinine during hospitalization (mg/dL)	1.3 ± 1.5
With positive blood culture	44 ± 31.7
Median time between admission and ERCP (h, range)	17 (1-240)
Who had ERCP within 24 h	104 (60.5)
Who had ERCP within 24-48 h	25 (14.5)
Who had ERCP within 48-72 h	14 (8.1)
Who has ERCP > 72 h	29 (16.9)
Purulent bile during ERCP	68 (40.5)
Dominant stricture during ERCP	32 (18.8)
Ampullary diverticulum	9 (5.3)
Balloon dilatation	69 (49.8)
Biliary sphincterotomy performed	50 (35.2)
Biliary stent placed	131 (77.1)
Pancreatic stent placed	14 (8.2)
Stone extraction	67 (39.2)
Failed ERCP	2 (1.2)
Complications post ERCP
Bleeding	2 (1.2)
Pancreatitis	3 (1.8)
Perforation	2 (1.2)

Data are expressed as absolute numbers (percentage) or mean ± SD. SIRS: Systemic inflammatory response syndrome; ERCP: Endoscopic retrograde cholangiopancreatography; BMI: Body mass index.

Table 2 Univariate analysis for adverse clinical outcome in 35 patients

Variable	OR (95%CI)	P value
Age	1.15 (1.02-1.30)	0.02
Male	0.90 (0.43-1.89)	0.78
Body mass index	1.23 (0.88-1.71)	0.23
Smoking	0.62 (0.22-1.72)	0.36
Primary sclerosing cholangitis	0.27 (0.09-0.82)	0.02
Systemic inflammatory response syndrome	5.46 (2.34-12.73)	< 0.001
Charlson comorbidity index	1.02 (0.85-1.23)	0.04
American Society of Anesthesiology physical classification	6.94 (3.14-15.33)	< 0.001
Altered mental status	1.31 (0.25-6.80)	0.61
Statins at admission	2.32 (0.97-5.57)	0.06
Anti-platelets meds at admission	2.18 (0.93-5.07)	0.07
Door to ERCP timing (> 72 h)	2.03 (0.83-4.95)	0.12
Pre-ERCP Bilirubin	1.05 (0.98-1.12)	0.20
Positive blood cultures	1.79 (0.79-4.10)	0.17
Presence of fever	2.87 (1.17-7.04)	0.02
Post ERCP bleeding	4.00 (0.24-65.59)	0.37
Presence of purulent bile at ERCP	1.41 (0.45 -5.40)	0.73
Transfer patients	0.72 (0.32-1.59)	0.41

ERCP: Endoscopic retrograde cholangiopancreatography.

Table 3 Multivariate analysis for adverse clinical outcome in 35 patients

Variable	OR (95%CI)	P value
American Society of Anesthesiology physical classification > 3	7.70 (2.73-24.4)	< 0.001
Systemic inflammatory response syndrome	3.67 (1.34-10.3)	0.01
Age (per 5 years)	1.05 (0.89-1.26)	0.54
Door to ERCP time > 72 h	3.36 (1.12-10.2)	0.03
Primary sclerosing cholangitis	0.41 (0.09 -1.49)	0.20
Bile duct stent placement	0.70 (0.23-2.19)	0.52
Charlson comorbidity index	0.89 (0.69-1.13)	0.37

ERCP: Endoscopic retrograde cholangiopancreatography.

Table 4 Univariate analysis for length of stay of greater than 10 d (90^th percentile)

Variable	OR (95%CI)	P value
Age	1.05 (0.92-1.19)	0.47
Male	0.98 (0.42-2.31)	0.97
Body mass index	1.07 (0.71-1.60)	0.74
Smoking	1.13 (0.37-3.41)	0.83
Primary sclerosing cholangitis	0.60 (0.21-1.71)	0.34
Systemic inflammatory response syndrome	2.02 (0.75-5.40)	0.16
Charlson comorbidity index	1.04 (0.85-1.28)	0.69
American Society of Anesthesiology physical classification > 3	3.12 (1.47-6.63)	0.003
Altered mental status	2.03 (0.39-10.67)	0.33
Statins at admission	0.90 (0.28-2.88)	1
Anti-platelets meds at admission	1.03 (0.35-3.01)	1
Door to ERCP time
≤ 24 h (reference)	-	-
24-48 h	2.66 (1.12-6.34)	0.03
48-72 h	2.82 (1.17-6.82)	0.02
> 72 h	3.57 (1.39-9.17)	0.03
Pre-ERCP bilirubin	1.07 (0.99-1.15)	0.08
Positive blood cultures	1.70 (0.69-4.21)	0.25
Presence of fever	1.04 (0.43-2.53)	0.94
Post-ERCP pancreatitis	3.00 (0.26-34.39)	0.38
Serum creatinine at admission	1.48 (1.13-1.94)	0.004
Presence of persistent cardiovascular failure	3.18 (1.15-8.79)	0.04
Presence of persistent respiratory failure	13.81 (2.38-80.11)	0.004
Presence of persistent renal failure	4.81 (1.74-13.29)	0.004
Transfer patients	0.93 (0.39-2.25)	0.87

ERCP: Endoscopic retrograde cholangiopancreatography.

Table 5 Multivariate analysis for mean length of stay

Variable	OR (95%CI)	P value
American Society of Anesthesiology physical classification (every 1 class)	1.34 (1.19-1.52)	< 0.001
Door to ERCP time
≤ 24 h (reference)	-	-
24-48 h	1.22 (0.97-1.54)	0.09
48-72 h	1.24 (0.92-1.66)	0.16
> 72 h	1.70 (1.36-2.12)	< 0.001
Pre-ERCP bilirubin (every 1 mg/dL)	1.02 (1.01-1.04)	0.02
Post-ERCP bleeding or pancreatitis	1.91 (1.12-3.24)	0.02
Charlson comorbidity index	1.01 (0.96-1.06)	0.74
Positive blood culture	1.18 (0.96-1.46)	0.12

Modeling of this outcome performed on the Log2 (length of stay), since this transformed variable had less skewness and much more symmetry in its distribution. ERCP: Endoscopic retrograde cholangiopancreatography.