Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2021-02-06

AUTHORS

Jean-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

ABSTRACT

BACKGROUND: 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... »

PAGES

49

Journal

TITLE

Critical Care

ISSUE

1

VOLUME

25

Author Affiliations

  • Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France
  • Groupe Hospitalier Sud Île-De-France (GHSIF), Service de réanimation polyvalente, Hôpital de Melun-Sénart, 77000 Melun, France
  • Assistance Publique – Hôpitaux de Paris (AP-HP), Service de médecine intensive et réanimation, Hôpital Cochin, 75014 Paris Cedex 12, France
  • Centre Hospitalier Argenteuil, Service de réanimation polyvalente et unité de surveillance continue, 95107 Argenteuil, France
  • Centre Hospitalier Universitaire Lille, Service de réanimation générale, Hôpital Salengro, 59037 Lille, France
  • Service de réanimation polyvalente, Hôpital Privé Claude Galien, 91480 Quincy-sous-Sénart, France
  • Service de médecine intensive et réanimation, Centre Hospitalier Universitaire Nantes, Hôtel-Dieu, 44000 Nantes, France
  • Centre Hospitalier Intercommunal Poissy Saint-Germain-en-Laye, Service de réanimation, Hôpital de Poissy, 78303 Poissy, France
  • Assistance Publique – Hôpitaux de Paris (AP-HP), Service de médecine intensive et réanimation, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
  • Centre Hospitalier Régional Universitaire Besançon, Service de réanimation médicale, Hôpital Jean Minjoz, 25030 Besançon, France
  • Centre Hospitalier de Saint-Denis, Service de réanimation et soins continus, Hôpital Delafontaine, 93205 Saint-Denis, France
  • Centre Hospitalier Sud Seine-et-Marne, Service de réanimation, Hôpital Fontainebleau, 77300 Fontainebleau, France
  • Assistance Publique – Hôpitaux de Paris (AP-HP), Centre d’endoscopie digestive, Hôpital Saint-Antoine, Paris, France
  • Sorbonne Université, Paris, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s13054-021-03480-1

    DOI

    http://dx.doi.org/10.1186/s13054-021-03480-1

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1135185782

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/33549136


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