Acute cholangitis due to common bile duct stones: Clinical outcomes in patients with and without concurrent acute pancreatitis

Abstract

BACKGROUND

Patients with concurrent acute biliary pancreatitis (ABP) and acute cholangitis (AC) may experience exacerbated clinical consequences due to bile duct stones. However, studies exploring this topic remain limited.

AIM

To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.

METHODS

This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2016 and December 2017. Patients were divided into two groups: AC with ABP (n = 90) and AC without ABP (n = 268). Clinical characteristics, laboratory data, ERCP results, primary study outcome [intensive care unit (ICU) admission], and secondary outcomes including 30-day mortality, length of hospital stay, and 30-day readmission rate were analyzed and compared.

RESULTS

All patients in the AC with ABP group had interstitial pancreatitis. The AC with ABP group had significantly higher white cell count (WBC) counts (13.1 × 10³/µL vs 10.4 × 10³/µL, P = 0.007) and more abnormal WBC results (61.1% vs 42.3%, P = 0.015). Liver biochemical tests, AC severity, ERCP success, adverse events, ICU admissions, 30-day mortality, hospital stay, and readmission rates did not differ significantly between the two groups. Univariate analysis showed no significant link between concurrent ABP and ICU admission, although significance was marginal in moderate/severe ABP cases (P = 0.051). In the multivariate analysis, age (P = 0.035) and cardiovascular dysfunction (P < 0.001) were independently associated with length of ICU stay.

CONCLUSION

Concurrent interstitial ABP and AC did not significantly affect outcomes. Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.

Keywords: Acute cholangitis; Acute pancreatitis; Atlanta classification; Clinical outcomes; Concurrent; Common bile duct stones; Endoscopic retrograde cholangiopancreatography; Tokyo guidelines

Core Tip: Concurrent acute cholangitis (AC) and acute biliary pancreatitis resulted in significantly higher white cell count (WBC) counts and abnormal WBC counts, suggesting a more intense inflammatory response. However, liver biochemical indices, AC severity, endoscopic retrograde cholangiopancreatography success or adverse events, and primary and secondary outcome measures did not differ significantly between the two groups. Multivariate analysis showed that age and cardiovascular dysfunction were independent factors for intensive care unit admission. Therefore, the presence of acute biliary pancreatitis in patients with AC does not appear to have a significant impact on intensive care unit admission rates or other major clinical outcomes.