Cholangitis: Analysis of admission prognostic indicators and outcomes

Acute cholangitis is a life-threatening complication of biliary obstruction that is exacerbated by delays in diagnosis and treatment. Since the introduction of endoscopic retrograde cholangiography and endoscopic therapeutic modalities, few investigations have addressed admission prognostic indicators of adverse outcomes. A retrospective review of all patients with a diagnosis of acute cholangitis from 1995 to 2005 was performed. Primary endpoints were organ failure and death. One-hundred and seventeen patients met criteria for acute cholangitis. Only 49 (42%) had Charcot's triad and 3 (3%) had Reynolds' pentad. One-hundred and four (89%) patients underwent biliary decompression, of which 79 (76%) were treated by endoscopic methods. There were 29 (25%) cases of organ failure and 9 (8%) deaths. The admission white blood cell (WBC) count (P = 0.0003) and total bilirubin (TBili) (P = 0.04) were statistically significant predictors of organ failure or death. With an admission of WBC ≥ 20,000 cells/mm³, the sensitivity, specificity, positive predictive value, and negative predictive value for organ failure and death were 50 per cent, 92 per cent, 63 per cent, and 88 per cent, respectively. A TBili of ≥10 mg/dL had sensitivity, specificity, positive predictive value, and negative predictive value of 56 per cent, 85 per cent, 21 per cent, and 96 per cent, respectively for predicting death. Admission WBC ≥ 20,000 cells/mm³ and TBili ≥ 10 mg/dL are selective predictors of adverse outcomes in acute cholangitis.