Shapera Emanuel A, Touadi Melissa, Kaspick Steven, Choy-Shin Jennifer, Lapucha Mateusz, Baumgarten Lauren, Johnson Matthew
General Surgery, Olde Del Mar Surgical, San Diego, USA.
School of Medicine, University of South Florida, Tampa, USA.
Cureus. 2023 Mar 10;15(3):e35989. doi: 10.7759/cureus.35989. eCollection 2023 Mar.
Background Acute ascending cholangitis is a life-threatening infection due to biliary obstruction. Decompression via endoscopic retrograde cholangiography (ERC) or interventional radiologic (IR) drainage controls the source of the sepsis. Numerous studies have been published with conflicting data on whether earlier drainage affects morbidity and mortality. We sought to publish our experience at two Las Vegas community hospitals. Methods After IRB approval, over 4000 inpatient non-elective ERCs were analyzed between 2010 and 2019. Six-hundred and twenty-five patients met the 2018 Tokyo criteria for a "definitive diagnosis" of acute ascending cholangitis. A univariate and multivariate analysis was conducted to identify factors significantly associated with length of stay and mortality. Results On univariate analysis, patients who had drainage conducted within 24 hours had significantly shorter lengths of stay (p = 0.0012 95% CI [-88.1 to -21.8 hrs]), higher mean diastolic blood pressure (p=0.0029 95% CI [1.03 to 5.01 mm Hg]), and lower mean maximum temperature (p=0.0001 95% CI [-0.842 to -0.382 C]) when compared to patients who underwent decompression more than 24 hours after admission. There were no statistically significant differences in mortality between patients who underwent decompression within 24 hours of admission versus patients who underwent decompression beyond 24 hours of admission. On multivariate analysis, earlier decompression reduced the length of stay for patients with mild (p<0.0001), moderate (p<0.0001), and severe cholangitis (p=0.0023). Mortality was significantly associated with the worsening severity of the cholangitis (moderate [p=0.0001] and severe [p<0.0001], but not mild disease) and the use of vasopressors. Conclusions Timely biliary decompression within 24 hours of admission significantly reduces the length of stay, pyrexia, and hemodynamic abnormalities. In addition, our data corroborate the 2018 Tokyo guidelines that correlate the severity of cholangitis with mortality.
急性化脓性胆管炎是一种因胆道梗阻而危及生命的感染性疾病。通过内镜逆行胆管造影术（ERC）或介入放射学（IR）引流进行减压可控制脓毒症的源头。关于早期引流是否会影响发病率和死亡率，已有众多研究发表，但数据相互矛盾。我们旨在公布我们在拉斯维加斯两家社区医院的经验。方法：经机构审查委员会（IRB）批准，对2010年至2019年间4000多例非择期住院ERC病例进行分析。625例患者符合2018年东京急性化脓性胆管炎“确诊”标准。进行单因素和多因素分析，以确定与住院时间和死亡率显著相关的因素。结果：单因素分析显示，与入院后24小时以上进行减压的患者相比，在24小时内进行引流的患者住院时间显著缩短（p = 0.0012，95%置信区间[-88.1至-21.8小时]），平均舒张压更高（p = 0.0029，95%置信区间[1.03至5.01毫米汞柱]），平均最高体温更低（p = 0.0001，95%置信区间[-0.842至-0.382℃]）。入院后24小时内进行减压的患者与入院后24小时以上进行减压的患者在死亡率方面无统计学显著差异。多因素分析显示，早期减压可缩短轻度（p < 0.0001）、中度（p < 0.0001）和重度胆管炎（p = 0.0023）患者的住院时间。死亡率与胆管炎严重程度加重（中度[p = 0.0001]和重度[p < 0.0001]，但轻度疾病无此关联）以及使用血管升压药显著相关。结论：入院后24小时内及时进行胆道减压可显著缩短住院时间、降低发热及血流动力学异常。此外,我们的数据证实了2018年东京指南中将胆管炎严重程度与死亡率相关联的观点。
