School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P.R. China; Department of Hepatobiliary Surgery, Dongyang People's Hospital; Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, P.R. China.
Department of Hepatobiliary Surgery, Dongyang People's Hospital; Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, P.R. China.
J Emerg Med. 2023 Oct;65(4):e280-e289. doi: 10.1016/j.jemermed.2023.05.013. Epub 2023 Jun 5.
This study evaluated the predictive value of different laboratory indicators for the severity of acute cholangitis (AC) according to the 2018 Tokyo Guidelines.
We enrolled consecutive patients with a diagnosis of AC from June 2016 to May 2021. Serum procalcitonin (PCT) and C-reactive protein (CRP) levels, white blood cell counts, the neutrophil-lymphocyte ratio, and the platelet-lymphocyte ratio (PLR) were compared according to the severity of AC.
In total, 293 patients were enrolled in this study (mild, n = 172; moderate, n = 68; severe, n = 53). In receiver operating characteristic analyses, CRP was the best biomarker for differentiating mild and moderate AC (area under the curve [AUC] 0.66, 95% confidence interval [CI] 0.58-0.74). PCT was the best biomarker for differentiating mild and severe AC (AUC 0.80, 95% CI 0.74-0.86). Blood culture was performed in 117 patients (39.93%), 53 of whom (45.30%) had positive results. Regarding blood culture positivity, PLR was most predictive (AUC 0.85, 95% CI 0.78-0.92).
PCT can be used as a reliable predictor of severe AC. CRP was most predictive of moderate AC, whereas PLR was most predictive of blood culture positivity.
本研究根据 2018 年东京指南，评估了不同实验室指标对急性胆管炎（AC）严重程度的预测价值。
我们连续纳入了 2016 年 6 月至 2021 年 5 月诊断为 AC 的患者。根据 AC 的严重程度比较了血清降钙素原（PCT）和 C 反应蛋白（CRP）水平、白细胞计数、中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值（PLR）。
本研究共纳入 293 例患者（轻度，n=172；中度，n=68；重度，n=53）。在受试者工作特征曲线分析中，CRP 是区分轻度和中度 AC 的最佳生物标志物（曲线下面积 [AUC] 0.66，95%置信区间 [CI] 0.58-0.74）。PCT 是区分轻度和重度 AC 的最佳生物标志物（AUC 0.80，95%CI 0.74-0.86）。对 117 例患者（39.93%）进行了血培养，其中 53 例（45.30%）阳性。关于血培养阳性，PLR 最具预测性（AUC 0.85，95%CI 0.78-0.92）。
PCT 可作为重度 AC 的可靠预测指标。CRP 对中度 AC 最具预测性，而 PLR 对血培养阳性最具预测性。
