Ontology type: schema:ScholarlyArticle Open Access: True
2021-02-06
AUTHORSJean-Rémi Lavillegrand, Emmanuelle Mercier-Des-Rochettes, Elodie Baron, Frédéric Pène, Damien Contou, Raphael Favory, Sébastien Préau, Arnaud Galbois, Chloé Molliere, Arnaud-Félix Miailhe, Jean Reignier, Mehran Monchi, Claire Pichereau, Sara Thietart, Thibault Vieille, Gael Piton, Gabriel Preda, Idriss Abdallah, Marine Camus, Eric Maury, Bertrand Guidet, Guillaume Dumas, Hafid Ait-Oufella
ABSTRACTBACKGROUND: Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). METHODS: Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis. RESULTS: Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5-11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50-147] and 19.1 µg/L [5.3-54.8]. Sixty-three percent of patients (n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54-0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05-1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08-1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12-1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones (p < 0.05) and AC complications (OR 2.74 [95% CI 1.45-5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30-6.22], p = 0.02). CONCLUSIONS: In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h. More... »
PAGES49
http://scigraph.springernature.com/pub.10.1186/s13054-021-03480-1
DOIhttp://dx.doi.org/10.1186/s13054-021-03480-1
DIMENSIONShttps://app.dimensions.ai/details/publication/pub.1135185782
PUBMEDhttps://www.ncbi.nlm.nih.gov/pubmed/33549136
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"description": "BACKGROUND: Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC).\nMETHODS: Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis.\nRESULTS: Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5-11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83\u00a0\u00b5mol/L [50-147] and 19.1\u00a0\u00b5g/L [5.3-54.8]. Sixty-three percent of patients (n\u2009\u2009=\u2009252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54-0.96] (p\u2009=\u20090.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05-1.24] by point, p\u2009=\u20090.001), lactate (OR 1.21 [95% CI 1.08-1.36], by 1\u00a0mmol/L, p\u2009<\u20090.001), total serum bilirubin (OR 1.26 [95% CI 1.12-1.41], by 50\u00a0\u03bcmol/L, p\u2009<\u20090.001), obstruction non-related to gallstones (p\u2009<\u20090.05) and AC complications (OR 2.74 [95% CI 1.45-5.17], p\u2009=\u20090.002). Time between ICU admission and biliary decompression\u2009>\u200948\u00a0h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30-6.22], p\u2009=\u20090.02).\nCONCLUSIONS: In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage\u2009>\u200948\u00a0h.",
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