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. 1989 Apr;209(4):435–438. doi: 10.1097/00000658-198904000-00008

Acute cholangitis. Multivariate analysis of risk factors.

J F Gigot 1, T Leese 1, T Dereme 1, J Coutinho 1, D Castaing 1, H Bismuth 1
PMCID: PMC1493983  PMID: 2930289

Abstract

In order to identify risk factors in patients with acute cholangitis, 140 clinical, biochemical, etiologic, and pathologic variables of 449 attacks of acute cholangitis seen in one center over a 20-year period were analyzed. Simple regression revealed 24 factors with prognostic significance, but multivariate analysis detected only seven factors with independent significance in predicting mortality (acute renal failure, cholangitis associated with liver abscesses or liver cirrhosis, cholangitis secondary to high malignant biliary strictures or after percutaneous transhepatic cholangiography, female gender, and age). When the presence of each of these factors is weighted proportional to its coefficient of regression, patients with cholangitis could be scored on a scale of 0-27. A score of seven was clinically the most useful cut off--388 attacks of cholangitis associated with a score of less than 7 had a mortality rate of only 1.8%, whereas 61 attacks associated with a score greater than or equal to 7 had a mortality rate of 49%. The value of this scoring system needs to be confirmed in prospective studies, but it may prove useful, for example, in selecting a group of high-risk patients for urgent biliary decompression in an attempt to reduce the mortality associated with this pathology.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andrew D. J., Johnson S. E. Acute suppurative cholangitis, a medical and surgical emergency. A review of ten years experience emphasizing early recognition. Am J Gastroenterol. 1970 Aug;54(2):141–154. [PubMed] [Google Scholar]
  2. Blamey S. L., Fearon K. C., Gilmour W. H., Osborne D. H., Carter D. C. Prediction of risk in biliary surgery. Br J Surg. 1983 Sep;70(9):535–538. doi: 10.1002/bjs.1800700910. [DOI] [PubMed] [Google Scholar]
  3. Boey J. H., Way L. W. Acute cholangitis. Ann Surg. 1980 Mar;191(3):264–270. doi: 10.1097/00000658-198003000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chock E., Wolfe B. M., Matolo N. M. Acute suppurative cholangitis. Surg Clin North Am. 1981 Aug;61(4):885–892. doi: 10.1016/s0039-6109(16)42486-2. [DOI] [PubMed] [Google Scholar]
  5. Dixon J. M., Armstrong C. P., Duffy S. W., Davies G. C. Factors affecting morbidity and mortality after surgery for obstructive jaundice: a review of 373 patients. Gut. 1983 Sep;24(9):845–852. doi: 10.1136/gut.24.9.845. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dow R. W., Lindenauer S. M. Acute obstructive suppurative cholangitis. Ann Surg. 1969 Feb;169(2):272–276. doi: 10.1097/00000658-196902000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Imrie C. W., Benjamin I. S., Ferguson J. C., McKay A. J., Mackenzie I., O'Neill J., Blumgart L. H. A single-centre double-blind trial of Trasylol therapy in primary acute pancreatitis. Br J Surg. 1978 May;65(5):337–341. doi: 10.1002/bjs.1800650514. [DOI] [PubMed] [Google Scholar]
  8. Leese T., Neoptolemos J. P., Baker A. R., Carr-Locke D. L. Management of acute cholangitis and the impact of endoscopic sphincterotomy. Br J Surg. 1986 Dec;73(12):988–992. doi: 10.1002/bjs.1800731214. [DOI] [PubMed] [Google Scholar]
  9. O'Connor M. J., Schwartz M. L., McQuarrie D. G., Sumer H. W. Acute bacterial cholangitis: an analysis of clinical manifestation. Arch Surg. 1982 Apr;117(4):437–441. doi: 10.1001/archsurg.1982.01380280031007. [DOI] [PubMed] [Google Scholar]
  10. OSTERMILLER W., Jr, THOMPSON R. J., Jr, CARTER R., HINSHAW D. B. ACUTE OBSTRUCTIVE CHOLANGITIS. Arch Surg. 1965 Mar;90:392–395. doi: 10.1001/archsurg.1965.01320090070016. [DOI] [PubMed] [Google Scholar]
  11. Pitt H. A., Cameron J. L., Postier R. G., Gadacz T. R. Factors affecting mortality in biliary tract surgery. Am J Surg. 1981 Jan;141(1):66–72. doi: 10.1016/0002-9610(81)90014-3. [DOI] [PubMed] [Google Scholar]
  12. REYNOLDS B. M., DARGAN E. L. Acute obstructive cholangitis; a distinct clinical syndrome. Ann Surg. 1959 Aug;150(2):299–303. doi: 10.1097/00000658-195908000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Ranson J. H., Rifkind K. M., Roses D. F., Fink S. D., Eng K., Spencer F. C. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974 Jul;139(1):69–81. [PubMed] [Google Scholar]
  14. Saharia P. C., Cameron J. L. Clinical management of acute cholangitis. Surg Gynecol Obstet. 1976 Mar;142(3):369–372. [PubMed] [Google Scholar]
  15. Saik R. P., Greenburg A. G., Farris J. M., Peskin G. W. Spectrum of cholangitis. Am J Surg. 1975 Aug;130(2):143–150. doi: 10.1016/0002-9610(75)90362-1. [DOI] [PubMed] [Google Scholar]
  16. Thompson J. E., Jr, Tompkins R. K., Longmire W. P., Jr Factors in management of acute cholangitis. Ann Surg. 1982 Feb;195(2):137–145. doi: 10.1097/00000658-198202000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Welch J. P., Donaldson G. A. The urgency of diagnosis and surgical treatment of acute suppurative cholangitis. Am J Surg. 1976 May;131(5):527–532. doi: 10.1016/0002-9610(76)90003-9. [DOI] [PubMed] [Google Scholar]

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