Zhao Jin, Wang Bin, Zhao Meidan, Pan Xinling
Department of Biomedical Sciences Laboratory.
Department of Hepatobiliary Surgery.
Eur J Gastroenterol Hepatol. 2025 Jan 1;37(1):33-38. doi: 10.1097/MEG.0000000000002849. Epub 2024 Sep 11.
Acute cholangitis is a clinical syndrome caused by a bacterial infection in the biliary system. The bacteria could exist in the bile before bile drainage despite empirical antibiotic treatment.
Patients with acute cholangitis admitted to a tertiary hospital in Southeastern China from August 2011 to September 2021 were involved when bile cultures were performed. Patient information before bile cultures and during hospitalization was extracted from the clinical record database. The risk factors related to bacteria in bile were assessed by univariable and multivairable logistic regression analysis, respectively.
A total of 533 patients (66.05%) had bacterial growth in bile. Alanine aminotransferase concentration [odds ratio (OR) = 0.998, P < 0.001], absolute monocyte count (OR = 0.335, P = 0.001), and duration of antibiotic use (OR = 0.933, P = 0.026) were negatively correlated with bacteria in bile. In contrast, C-reactive protein (OR = 1.006, P = 0.003), thrombin time (OR = 1.213, P = 0.033), prothrombin time (OR = 1.210, P = 0.011), and age (OR = 1.025, P < 0.001) were positively correlated with bacteria in bile. Based on an area under the receiver operating characteristic curve of 0.737 (95% CI, 0.697-0.776, P < 0.001), combining these seven variables could efficiently predict the presence of bacteria in bile among patients with acute cholangitis.
The combination of clinical indicators before bile drainage could predict the risk of bacteria in bile for patients with acute cholangitis.
急性胆管炎是一种由胆道系统细菌感染引起的临床综合征。尽管进行了经验性抗生素治疗，但在胆汁引流前细菌可能已存在于胆汁中。
纳入2011年8月至2021年9月在中国东南部一家三级医院住院的急性胆管炎患者，进行胆汁培养。从临床记录数据库中提取胆汁培养前及住院期间的患者信息。分别通过单变量和多变量逻辑回归分析评估与胆汁中细菌相关的危险因素。
共有533例患者（66.05%）胆汁中细菌生长。丙氨酸转氨酶浓度[比值比（OR）=0.998，P<0.001]、单核细胞绝对计数（OR=0.335，P=0.001）和抗生素使用时间（OR=0.933，P=0.026）与胆汁中细菌呈负相关。相比之下，C反应蛋白（OR=1.006，P=0.003）、凝血酶时间（OR=1.213，P=0.033）、凝血酶原时间（OR=1.210，P=0.011）和年龄（OR=1.025，P<0.001）与胆汁中细菌呈正相关。基于受试者工作特征曲线下面积为0.737（95%CI，0.697-0.776，P<0.001）,联合这七个变量可有效预测急性胆管炎患者胆汁中细菌的存在情况。
胆汁引流前的临床指标联合可预测急性胆管炎患者胆汁中存在细菌的风险。
