用于预测急性胆管炎30天死亡率的诊断性炎症生物标志物
Diagnostic Inflammation Biomarkers for Prediction of 30-Day Mortality Rate in Acute Cholangitis.
作者信息
Al-Yahri Omer, Al-Zoubi Raed M, Elhuda Azza Alam, Ahmad Amina, Al Dhaheri Mahmood, Abdelaziem Sherif, Alwani Mustafa, Al-Qudimat Ahmad R, Zarour Ahmad
机构信息
Acute care Surgery division, Department of Surgery, Hamad Medical Corporation, Doha, QA.
Department of Chemistry, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan.
出版信息
Int J Surg Protoc. 2022 Mar 2;26(1):14-21. doi: 10.29337/ijsp.170. eCollection 2022.
BACKGROUND
Acute cholangitis (AC) is an acute inflammation and infection of the biliary tract, a potentially life-threatening infection, which is usually associated with biliary tree obstruction and impairment of bile flow from the liver to the duodenum. AC is classified by severity from mild, moderate to severe infection (grade I to III, respectively).
METHODS
This study recruited a retrospective cohort from Jan 2015 to July 2018. Overall, 294 patients of age ≥ 18 years with AC were enrolled. The study was conducted according to the World Medical Association Declaration of Helsinki. Demographic and laboratory data were collected for analysis. T-Bilirubin and other laboratory results were collected and analyzed using independent and ANOVA for continuous values and multivariate COX regression for survival analysis for identifying independent factors for early mortality. The cut-off threshold of T-bilirubin was determined by calculating the area under the receiver operating characteristic (ROC) curve.
RESULTS
There were 213 male and 81 female patients and mean age ± SD of patients was 49.57 ± 16.1 and 56.12 ± 20.18 respectively. 31.9% patients were found older than 60 years of age and 35% patients were found between 30-45 years of age. T-bilirubin and length of hospital stay (LOS) were found statistically significant (P < 0.05) in relation to mortality in AC patients. The area under ROC curve for T-bilirubin level (P = 0.017, OR = 1.010) was 0.717 (95% CI, 6.25-168.9) and this is consistent with the Cut-off point for more than or equal to 38.6 µmol/L (2.26 mg/dL).
CONCLUSIONS
In this study, T-bilirubin level is found to be significantly related to short-term mortality in AC. Further studies are still needed with larger cohorts to shed more light on these findings.
HIGHLIGHTS
Herein, we report a retrospective observational study aiming to evaluate biomarkers contributing to mortality in AC and to determine the cut-off diagnostic levels that could be easily used in emergency setting. Overall, 294 patients of age ≥ 18 years with AC were enrolled. The study was conducted according to the World Medical Association Declaration of Helsinki and approved by Institutional Review Board (IRB) with approval: MRC-01-20-823 at Hamad Medical Corporation (HMC). Demographic and laboratory data were collected for analysis. Total-Bilirubin and other laboratory results were collected and analyzed using independent T-test and ANOVA for continuous values and multivariate COX regression for survival analysis for identifying independent factors for early mortality. The cut-off threshold of T-bilirubin was determined by calculating the area under the receiver operating characteristic (ROC) curve. There were 213 male and 81 female patients and mean age ± SD of patients was 49.57 ± 16.1 and 56.12 ± 20.18 respectively. 31.9% patients were found older than 60 years of age and 35% patients were found between 30-45 years of age. T-bilirubin and length of hospital stay (LOS) were found statistically significant (P < 0.05) in relation to mortality in AC patients. The area under ROC curve for T-bilirubin level (P = 0.037, OR = 1.010) was 0.717 (95% CI, 6.25-168.9) and this is consistent with the Cut-off point for more than or equal to 38.6 μmol/L (2.26 mg/dL).
背景
急性胆管炎（AC）是胆道的急性炎症和感染，是一种潜在的危及生命的感染，通常与胆管梗阻以及胆汁从肝脏流入十二指肠受阻有关。AC按严重程度分为轻度、中度和重度感染（分别为I至III级）。
方法
本研究纳入了2015年1月至2018年7月的回顾性队列。总体而言，纳入了294例年龄≥18岁的AC患者。本研究按照世界医学协会《赫尔辛基宣言》进行。收集人口统计学和实验室数据进行分析。收集总胆红素（T - 胆红素）和其他实验室结果，对连续值使用独立样本t检验和方差分析，对生存分析使用多变量COX回归以确定早期死亡的独立因素。通过计算受试者工作特征（ROC）曲线下面积来确定T - 胆红素的截断阈值。
结果
有213例男性和81例女性患者，患者的平均年龄±标准差分别为49.57±16.1岁和56.12±20.18岁。发现31.9%的患者年龄大于60岁，35%的患者年龄在30 - 45岁之间。发现T - 胆红素和住院时间（LOS）与AC患者的死亡率具有统计学意义（P < 0.05）。T - 胆红素水平的ROC曲线下面积为0.717（95%CI，6.25 - 168.9）（P = 0.017，OR = 1.01），这与截断点≥38.6 μmol/L（2.26 mg/dL）一致。
结论
在本研究中，发现T - 胆红素水平与AC患者的短期死亡率显著相关。仍需要更大队列的进一步研究来更清楚地阐明这些发现。
要点
在此，我们报告一项回顾性观察性研究，旨在评估导致AC患者死亡的生物标志物，并确定可在急诊环境中轻松使用的截断诊断水平。总体而言，纳入了294例年龄≥18岁的AC患者。本研究按照世界医学协会《赫尔辛基宣言》进行，并获得机构审查委员会（IRB）批准：哈马德医疗公司（HMC）的MRC - 01 - 20 - 823。收集人口统计学和实验室数据进行分析。收集总胆红素和其他实验室结果，对连续值使用独立样本t检验和方差分析，对生存分析使用多变量COX回归以确定早期死亡的独立因素。通过计算受试者工作特征（ROC）曲线下面积来确定T - 胆红素的截断阈值。有213例男性和81例女性患者，患者的平均年龄±标准差分别为49.57±16.1岁和56.12±20.18岁。发现31.9%的患者年龄大于60岁，35%的患者年龄在30 - 多变量COX回归以确定早期死亡的独立因素。通过计算受试者工作特征（ROC）曲线下面积来确定T - 胆红素的截断阈值。有213例男性和81例女性患者，患者的平均年龄±标准差分别为49.57±16.1岁和56.12±20.18岁。发现31.9%的患者年龄大于60岁，35%的患者年龄在30 - 45岁之间。T - 胆红素水平的ROC曲线下面积为0.717（95%CI，6.25 - 168.9）（P = 0.037，OR = 1.01），这与截断点≥38.6 μmol/L（2.26 mg/dL）一致。
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