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

BackgroundLittle is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC).MethodsRetrospective 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.ResultsOverall, 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).ConclusionsIn 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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    26 schema:description BackgroundLittle is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC).MethodsRetrospective 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.ResultsOverall, 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).ConclusionsIn 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.
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