Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD 21205, USA.
Clin Gastroenterol Hepatol. 2012 Oct;10(10):1157-61. doi: 10.1016/j.cgh.2012.03.029. Epub 2012 Apr 13.
BACKGROUND & AIMS: Acute ascending cholangitis usually is treated with antibiotics, and biliary drainage is treated by endoscopic retrograde cholangiopancreatography (ERCP). We investigated the effects of the timing of ERCP on outcomes of patients with acute cholangitis factors that predict prolonged hospital stays, increased costs of hospitalization, and composite clinical outcomes (death, persistent organ failure, and admission to the intensive care unit).
We performed a retrospective analysis of data from 90 patients (mean age, 60 y; 48% female) admitted to Johns Hopkins Hospital from January 1994 to June 2010 who were diagnosed with acute cholangitis and underwent ERCP. A delayed ERCP was defined as one performed more than 72 hours after admission. Electronic and paper medical records were reviewed, and relevant data were abstracted.
ERCP was performed successfully in 92% of the patients, at a mean time period of 38 hours after admission (14% of ERCPs were delayed). Factors that were associated independently with prolonged length of hospital stay (top 10%) included unsuccessful ERCP (odds ratio [OR], 52.5; P = .002) and delayed ERCP (OR, 19.8; P = .008). Factors associated with increased hospitalization cost (top 10%) included unsuccessful ERCP (OR, 33.8; P = .004) and delayed ERCP (OR, 11.3; P = .03). Factors associated with composite clinical outcome included age (OR, 1.1; P = .01), total level of bilirubin (OR, 1.36; P = .002), and delayed ERCP (OR, 7.8; P = .04).
Delayed and failed ERCP are associated with prolonged hospital stays and increased costs of hospitalization. Delayed ERCP is associated with composite clinical outcome (death, persistent organ failure, and/or intensive care unit stay). Older age and higher levels of bilirubin also are associated with patients' composite end point.
急性上行性胆管炎通常采用抗生素治疗，胆道引流采用内镜逆行胰胆管造影（ERCP）治疗。我们研究了 ERCP 时机对急性胆管炎患者结局的影响，以及预测住院时间延长、住院费用增加和复合临床结局（死亡、持续器官衰竭和入住重症监护病房）的因素。
我们对 1994 年 1 月至 2010 年 6 月期间在约翰霍普金斯医院就诊并接受 ERCP 治疗的 90 名急性胆管炎患者进行了回顾性数据分析。延迟 ERCP 定义为入院后超过 72 小时进行的 ERCP。电子病历和纸质病历均进行了审查，并提取了相关数据。
92%的患者成功进行了 ERCP，平均在入院后 38 小时进行（14%的 ERCP 延迟）。与住院时间延长（前 10%）独立相关的因素包括 ERCP 失败（比值比 [OR]，52.5；P=.002）和延迟 ERCP（OR，19.8；P=.008）。与住院费用增加（前 10%）独立相关的因素包括 ERCP 失败（OR，33.8；P=.004）和延迟 ERCP（OR，11.3；P=.03）。与复合临床结局独立相关的因素包括年龄（OR，1.1；P=.01）、总胆红素水平（OR，1.36；P=.002）和延迟 ERCP（OR，7.8；P=.04）。
延迟和失败的 ERCP 与住院时间延长和住院费用增加有关。延迟 ERCP 与复合临床结局（死亡、持续器官衰竭和/或入住重症监护病房）有关。年龄较大和胆红素水平较高也与患者的复合终点有关。
