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

Table 1 Demographic, laboratory, and clinical characteristics, n (%)

Variables	AC with ABP, n = 90	AC without ABP, n = 268	P value
Age in years	73 (64-82)	63 (52-75)	0.305
Male sex	52 (57.8)	154 (57.5)	0.958
Body temperature in °C	37.4 (36.9-38.0)	37.5 (36.9-38.4)	0.797
WBC count as × 103/µL	13.1 (9.2-17.3)	10.4 (8.5-15.3)	0.007
Abnormal WBC count	55 (61.1)	124 (42.3)	0.015
AST in U/L	178.5 (83-261)	193 (111-468)	0.722
ALT in U/L	175 (89.5-290.5)	222 (136-447)	0.790
ALK-P in U/L	215 (135.5-300.5)	181 (123-267)	0.316
Total bilirubin in mg/dL	3.5 (2.1-5.3)	3.6 (2.5-6.2)	0.795
Creatinine in mg/dL	1.08 (0.90-1.27)	0.88 (0.73-1.15)	0.201
Amylase	1165 (611-2368)	47.6 (40.0-69.4)	< 0.01
Lipase	2054 (1128-4289)	28 (24-40)	< 0.01
Blood culture performed, n = 293	73 (81.1)	220 (82.1)	0.835
Positive blood culture	14/73 (19.2)	57/220 (25.9)	0.245
Gallbladder status
In situ with stone	55 (61.1)	156 (58.2)	0.069
In situ without stone	28 (31.1)	63 (23.5)	0.152
Post cholecystectomy	7 (7.8)	49 (18.3)	0.018
CBDS on images before ERCP	61 (67.8)	171 (63.8)	0.495
Abdominal ultrasound, n = 89	1/19 (5.3)	9/70 (12.9)	0.353
CT scan, n = 356	58/90 (64.4)	154/266 (57.9)	0.274
MRCP, n = 19	3/4 (75)	15/15 (100)	0.047
Median CBDS diameter in mm	5.6 (4.0-8.7)	6.8 (4.7-10.0)	0.775
Severity of AC
Mild	39 (43.3)	141 (52.6)	0.088
Moderate	28 (31.1)	71 (26.5)	0.397
Severe	23 (25.6)	56 (20.9)	0.356
Organ dysfunction
Cardiovascular	4 (4.4)	12 (4.5)	0.989
Neurological	6 (6.7)	14 (5.2)	0.606
Respiratory	6 (6.7)	7 (2.6)	0.075
Renal	11 (12.2)	20 (7.5)	0.165
Hepatic	4 (4.4)	3 (1.1)	0.044
Hematological	8 (8.9)	16 (6.0)	0.352

Data are presented as n (%) or median (interquartile range) unless otherwise defined. ABP: Acute biliary pancreatitis; AC: Acute cholangitis; ALK-P: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CBDS: Common bile duct stone; ERCP: Endoscopic retrograde cholangiopancreatography; MRCP: Magnetic resonance cholangiopancreatography.

Table 2 Outcomes of endoscopic retrograde cholangiopancreatography, n (%)

Variables	AC with ABP, n = 90	AC without ABP, n = 268	P value
Time to ERCP in hours
Overall population	45.4 (30.4-69.3)	62.6 (26.0-83.1)	0.030
Mild AC	42.1 (18.4-71.8)	46.3 (28.6-84.0)	0.243
Moderate AC	35.9 (19.5-57.6)	46.6 (28.9-76.4)	0.029
Severe AC	63.4 (28.6-91.8)	67.5 (28.8-94.6)	0.538
ERCP procedure
Successful biliary cannulation	90 (100)	264 (98.5)	0.244
Papillary procedures, n = 354
EST	89 (98.9)	253 (94.4)	0.167
EPBD	0	4 (1.5)	0.241
No EST or EPBD	1 (1.1)	10 (3.7)	0.206
Bile duct sweep, n = 341	86 (95.6)	255 (95.1)	0.844
With stones	72/86 (83.7)	230/255 (90.2)	0.103
Without stones	14/86 (16.3)	25/255 (9.8)	0.103
Stent insertion	5 (5.6)	23 (8.6)	0.338
Adverse event due to ERCP	5 (5.6)	14 (5.2)	0.921
Delayed bleeding	2 (2.2)	6 (2.2)	0.982
Pancreatitis	0	6 (1.9)	0.344
AC	2 (2.2)	1 (0.4)	0.159
Perforation	2 (2.2)	1 (0.4)	0.159

Data are presented as n (%) or median (interquartile range) unless otherwise defined. ABP: Acute biliary pancreatitis; AC: Acute cholangitis; EPBD: Endoscopic papillary balloon dilatation; ERCP: Endoscopic retrograde cholangiopancreatography; EST: Endoscopic sphincterotomy.

Table 3 Primary and secondary outcomes, n (%)

Variables	AC with ABP, n = 90	AC without ABP, n = 268	P value
Overall population	(n = 90)	(n = 268)
ICU admission	6 (6.7)	12 (4.5)	0.411
30-day mortality	1 (1.1)	1 (0.4%)	0.416
LOHS in days	7.0 (5.5-9.5)	7.0 (5.0-9.0)	0.554
30-day readmission	8 (8.9)	18 (6.7)	0.492
Mild AC	(n = 39)	(n = 141)
ICU admission	0	0
30-day mortality	0	0
LOHS in days	6.0 (5.0-8.0)	6.0 (5.0-8.0)	0.823
30-day readmission	4 (10.2)	5 (3.5)	0.097
Moderate AC	(n = 28)	(n = 71)
ICU admission	0	0
30-day mortality	0	0
LOHS in days	6.0 (5.0-8.5)	6.0 (5.0-9.0)	0.666
30-day readmission	1 (3.6)	7 (9.9)	0.301
Severe AC	(n = 23)	(n = 56)
ICU admission	6 (26.0)	12 (21.4)	0.201
30-day mortality	3 (13.0)	6 (10.7)	0.510
LOHS in days	9.0 (7.0-10.5)	7.5 (6.0-11.0)	0.409
30-day readmission	3 (13.0)	6 (10.7)	0.767

Data are presented as n (%) or median (interquartile range) unless otherwise defined. ABP: Acute biliary pancreatitis; AC: Acute cholangitis; ICU: Intensive care unit; LOHS: Length of hospital stay.

Table 4 30-day readmission causes, n (%)

Reason	AC with ABP, n = 90	AC without ABP, n = 268	Overall, n = 358
Acute cholecystitis	1 (1.1)	2 (0.8)	3 (0.8)
Acute pancreatitis	2 (2.2)	1 (0.4)	3 (0.8)
AC	0	4 (1.5)	4 (1.1)
Post-EST bleeding	0	2 (0.8)	2 (0.6)
Scheduled laparoscopic cholecystectomy	3 (3.3)	4 (1.5)	7 (2.0)
Other unrelated disorders	2 (2.2)	5 (1.9)	7 (2.0)

Data are presented as n (%). ABP: Acute biliary pancreatitis; AC: Acute cholangitis; EST: Endoscopic sphincterotomy.

Table 5 Univariate and multivariate analyses of factors associated with intensive care unit admission, n (%)

Factor		Univariate analysis		Multivariate analysis
		OR (95%CI)	P value	OR (95%CI)	P value
Age	Every 1-year increase	1.103 (1.050-1.159)	< 0.001	1.179 (1.012-1.373)	0.035
Sex	Male	2.218 (0.839-5.862)	0.108
WBC count		1.148 (0.555-1.230)	< 0.001	1.014 (0.875-1.174)	0.857
Acute pancreatitis	Yes	1.524 (0.670-4.186)	0.414
Severe plus moderate acute pancreatitis	Yes	5.462 (0.992-30.077)	0.051
Time to ERCP within 12 hours	Yes	6.880 (2.211-21.414)	< 0.001	11.984 (0.346-415.629)	0.170
Any ERCP-related AE	Yes	6.133 (1.800-20.897)	0.004	3.123 (0.125-77.908)	0.488
Cardiovascular dysfunction1	Yes	292.067 (62.939-1355.333)	< 0.001	1201.997 (28.078-51457.080)	< 0.001
Neurological dysfunction (conscious disturbance)	Yes	29.909 (9.935-90.038)	< 0.001	28.347 (1.829-439.339)	28.347
Respiratory dysfunction (PaO2/FiO2 ratio < 300)	Yes	Infinite	0.998
Renal dysfunction (Cr > 2.0 mg/dL)	Yes	2.229 (0.608-8.165)	0.226
Hepatic dysfunction (PT-INR > 1.5)	Yes	15.375 (3.135-75.408)	< 0.001	2.443 (0.077-77.235)	0.612
Hematological dysfunction (PLT < 100 × 103/µL)	Yes	3.010 (0.807-11.220)	0.101

¹Cardiovascular dysfunction: Hypotension requiring treatment with dopamine 5 µg/kg per minute, or any dose of norepinephrine.

AE: Adverse event; CI: Confidence interval; Cr: Creatine; ERCP: Endoscopic retrograde cholangiopancreatography; FiO₂: Fraction of inspired oxygen; OR: Odds ratio; PaO₂: Partial pressure of oxygen; PLT: Platelet; PT-INR: Prothrombin time-international normalized ratio.