Hypoalbuminemia as a predictor of mortality in patients with acute cholangitis: A systematic review and meta-analysis

Abstract

BACKGROUND

Acute cholangitis is a potentially life-threatening infection of the biliary tract and its mortality rate is between 10%-30%. Early risk stratification is essential for the best possible outcome. Serum albumin, an index of the inflammatory and nutritional state, has been associated with adverse outcome in various acute conditions.

AIM

To assess the value of hypoalbuminemia as a predictor of mortality in acute cholangitis.

METHODS

A systematic search of PubMed, Web of Science, Semantic Scholar, Cochrane Library, and Google Scholar was performed up to May 2025. Eligible studies included adults diagnosed with acute cholangitis and reported mortality outcomes stratified by serum albumin levels. Data extraction was conducted independently by two reviewers, and study quality was assessed using the Newcastle–Ottawa Scale. Pooled odds ratios (OR) with 95%CI were calculated using a random-effects model. Heterogeneity was assessed with the I² statistic, while publication bias was evaluated through funnel plot symmetry and Egger’s regression test.

RESULTS

Eight retrospectively assembled cohort studies enrolling a total of 2215 of patients with acute cholangitis were incorporated in this meta-analysis. Mean age of the patient was greater than 65 years. Among them, 52.2% were males. Out 2215 patients, 242 (10.9%) died. Hypoalbuminemia was highly associated with increased mortality. Dichotomous outcome analysis demonstrated strong evidence of association between hypoalbuminemia and mortality (OR = 8.02, 95%CI: 3.41-18.83; P ≤ 0.001; I² = 50%). Continuous outcome analysis demonstrated a 23% increased risk of mortality associated with every 1 g/dL fall in serum albumin (OR = 0.77, 95%CI: 0.64-0.93; P = 0.005; I² = 66%). All the incorporated studies were of high methodological quality with minimal evidence of publication bias.

CONCLUSION

Hypoalbuminemia on hospital admission is a strong and independent predictor of death in patients with acute cholangitis. Admission serum albumin measurement provides a simple, cost-effective, and universally available method of early risk stratification. Prospective studies in the future need to examine whether correction of hypoalbuminemia improves clinical outcomes.

Keywords: Acute cholangitis; Hypoalbuminemia; Mortality; Prognosis; Prediction; Inflammatory marker

Core Tip: Early recognition of high-risk patients is essential in acute cholangitis. This meta-analysis shows that hypoalbuminemia is strongly linked to mortality, making serum albumin a practical bedside marker. Being inexpensive and widely available, albumin measurement at admission can guide clinicians toward intensified monitoring, early biliary drainage, and tailored therapy, ultimately improving survival outcomes in this life-threatening condition.