Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9857
Peer-review started: June 22, 2021
First decision: July 26, 2021
Revised: July 28, 2021
Accepted: August 27, 2021
Article in press: August 27, 2021
Published online: November 16, 2021
Processing time: 140 Days and 20.3 Hours
Acute cholangitis is an acute inflammatory reaction caused by bacterial infection in the biliary tract. It progresses rapidly and can develop into sepsis or septic shock. The grade of cholangitis can guide clinical treatment and predict the prognosis of patients. Acute cholangitis is currently graded based on age, temperature, white blood cell (WBC) count, total bilirubin (T-Bil) levels, hypoalbuminemia, and organ/system dysfunction.
Appropriate use of biliary drainage and antibiotics has observably reduced the mortality rate for acute cholangitis. However, the Tokyo Guidelines 2018 (TG18): Diagnostic Criteria and Severity Grading for Acute Cholangitis is a comprehensive criterion and is cumbersome to use in the emergency department.
Presepsin is a promising biomarker for the early diagnosis, severity, and prognosis of acute bacterial infections. To simplify grading, we wanted to evaluate the grading value of presepsin in patients with acute cholangitis.
Clinical observational trials were conducted in Beijing Friendship Hospital from 2019 to 2020. Whole blood was collected from patients with acute cholangitis for measuring WBC count, C-reactive protein (CRP), procalcitonin (PCT), presepsin, T-Bil and other clinical biochemical indices. Presepsin levels were measured using the PATHFAST analyzer.
A total of 336 patients were divided into mild, moderate, and severe groups based on the TG18. The area under the receiver operating characteristic curve (AUC) of presepsin in predicting moderate acute cholangitis was 0.728, prominently higher than that of CRP and PCT. The AUC of presepsin in predicting severe acute cholangitis was 0.715, which was higher than that of WBC count, CRP, PCT, and T-Bil. The WBC count, PCT, and presepsin levels in the positive blood culture group were greater than those in the negative blood culture group, and presepsin had the highest AUC.
Presepsin can help predict the positive blood culture, and is also superior to WBC count, CRP, PCT, and T-Bil in the risk stratification of acute cholangitis.
Timely determination of presepsin levels can help clinicians identify the severity of patients with acute cholangitis early. Presepsin may be an ideal biomarker for simplified grading of acute cholangitis.