Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Japan.
Intern Med. 2023 Oct 1;62(19):2795-2802. doi: 10.2169/internalmedicine.0945-22. Epub 2023 Feb 15.
Objective A positive hemoculture in acute cholangitis is serious, but a blood culture result cannot be obtained at the initial diagnosis and so cannot be used for the severity assessment and decision-making concerning urgent/early biliary drainage. Accordingly, a predictor for bacteremia at the initial diagnosis of acute cholangitis would be particularly useful. We investigated the association between neutrophil proportions in white blood cell counts (%Neutro) and bacteremic acute cholangitis. Methods Of 166 patients with acute cholangitis who were diagnosed with the Tokyo Guidelines 2018/2013 from April 2015 to March 2017, a total of 94 underwent blood culture assessments and were divided into those with a positive hemoculture (n=48) and a negative hemoculture (n=46) and then compared. A receiver operating characteristic curve analysis was used to evaluate the predictive ability of %Neutro and other inflammatory markers. Results The %Neutro values were significantly higher in the positive hemoculture group than in the negative hemoculture group (91.7±4.0% vs. 82.5±9.0%, p<0.0001). A cut-off %Neutro value of 89.7% was strongly associated with bacteremia (area under the curve 0.86, sensitivity 77.1%, specificity 80.4%). A %Neutro of ≥89.7% was a predictor of a positive hemoculture in univariate (p<0.0001) and multivariate analyses (p<0.001). Patients with a %Neutro ≥89.7% needed early biliary drainage more frequently than others (30/46, 65.2% vs. 18/48, 37.5%, p=0.0063). Conclusion %Neutro is an independent predictor of bacteremia in patients with acute cholangitis and may contribute to decision-making concerning early biliary drainage.
急性胆管炎合并血培养阳性较为严重，但初始诊断时往往无法获得血培养结果，因此无法用于评估疾病严重程度并决定是否需要紧急/早期胆道引流。因此，对于急性胆管炎的初始诊断，一个预测菌血症的指标将非常有用。本研究旨在探讨白细胞计数中性粒细胞比例（%Neutro）与菌血症性急性胆管炎之间的关系。
2015 年 4 月至 2017 年 3 月，根据 2018/2013 年东京指南诊断为急性胆管炎的 166 例患者中，共有 94 例行血培养检查，根据血培养结果分为血培养阳性组（n=48）和血培养阴性组（n=46），并进行比较。采用受试者工作特征曲线分析评估%Neutro和其他炎症标志物的预测能力。
血培养阳性组的%Neutro 值明显高于血培养阴性组（91.7±4.0% vs. 82.5±9.0%，p<0.0001）。%Neutro 截断值为 89.7%时与菌血症密切相关（曲线下面积 0.86，敏感度 77.1%，特异度 80.4%）。单因素（p<0.0001）和多因素分析（p<0.001）均表明，%Neutro≥89.7%是血培养阳性的预测指标。%Neutro≥89.7%的患者比其他患者更需要早期胆道引流（30/46，65.2% vs. 18/48，37.5%，p=0.0063）。
%Neutro 是急性胆管炎患者菌血症的独立预测指标，可能有助于决策是否需要早期胆道引流。
