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Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study
Acute suppurative cholangitis (ASC) lacks sensitive and specific preoperative diagnostic criteria. Some researchers suggest treating ASC as severe cholangitis. This study aimed to explore the relationship between the Tokyo Guidelines 2018 (TG18) grading system for acute cholangitis (AC) and the diag...
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Published in: | BMC gastroenterology 2024-09, Vol.24 (1), p.322-12, Article 322 |
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description | Acute suppurative cholangitis (ASC) lacks sensitive and specific preoperative diagnostic criteria. Some researchers suggest treating ASC as severe cholangitis. This study aimed to explore the relationship between the Tokyo Guidelines 2018 (TG18) grading system for acute cholangitis (AC) and the diagnosis of acute suppurative cholangitis (ASC), searching for independent risk factors of ASC and develop a nomogram to discriminate ASC from acute nonsuppurative cholangitis (ANSC) accurately.
After applying the inclusion and exclusion criteria, 401 patients with acute cholangitis (AC) were retrospectively analyzed at Nanjing First Hospital between January 2015 and June 2023. SPSS version 27.0 and R studio software were used to analyze data obtained from medical records. The results were validated in a prospective cohort of 82 AC patients diagnosed at Nanjing First Hospital between July 2023 and February 2024.
Among the 401 patients, 102 had suppurative bile (the ASC group; AC grade I: 40 [39.2%], AC grade II: 27 [26.5%], AC grade III: 35 [34.3%]), whereas 299 did not have (the ANSC group; AC grade I: 157 [52.5%], AC grade II: 92 [30.8%], AC grade III: 50 [16.7%]). The specificity of ASC for diagnosing moderate-to-severe cholangitis is 79.7%. Multivariate logistic regression analysis identified concurrent cholecystitis, CRP, PCT, TBA, and bile duct diameter as independent risk factors for suppurative bile, and all of these factors were included in the nomogram. The calibration curve exhibited consistency between the nomogram and the actual observation, and the area under the curve was 0.875 (95% confidence interval: 0.835-0.915), sensitivity was 86.6%, and specificity was 75.5%.
Suppurative bile is a specific indicator for diagnosing moderate-to-severe cholangitis. However, diagnosing ASC with AC grade II and AC grade III has the risk of missed diagnosis as the sensitivity is only 60.8%. To improve the diagnostic rate of ASC, this study identified concurrent cholecystitis, CRP, PCT, TBA, and preoperative bile duct diameter as independent risk factors for ASC, and a nomogram was developed to help physicians recognize patients with ASC. |
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After applying the inclusion and exclusion criteria, 401 patients with acute cholangitis (AC) were retrospectively analyzed at Nanjing First Hospital between January 2015 and June 2023. SPSS version 27.0 and R studio software were used to analyze data obtained from medical records. The results were validated in a prospective cohort of 82 AC patients diagnosed at Nanjing First Hospital between July 2023 and February 2024.
Among the 401 patients, 102 had suppurative bile (the ASC group; AC grade I: 40 [39.2%], AC grade II: 27 [26.5%], AC grade III: 35 [34.3%]), whereas 299 did not have (the ANSC group; AC grade I: 157 [52.5%], AC grade II: 92 [30.8%], AC grade III: 50 [16.7%]). The specificity of ASC for diagnosing moderate-to-severe cholangitis is 79.7%. Multivariate logistic regression analysis identified concurrent cholecystitis, CRP, PCT, TBA, and bile duct diameter as independent risk factors for suppurative bile, and all of these factors were included in the nomogram. The calibration curve exhibited consistency between the nomogram and the actual observation, and the area under the curve was 0.875 (95% confidence interval: 0.835-0.915), sensitivity was 86.6%, and specificity was 75.5%.
Suppurative bile is a specific indicator for diagnosing moderate-to-severe cholangitis. However, diagnosing ASC with AC grade II and AC grade III has the risk of missed diagnosis as the sensitivity is only 60.8%. To improve the diagnostic rate of ASC, this study identified concurrent cholecystitis, CRP, PCT, TBA, and preoperative bile duct diameter as independent risk factors for ASC, and a nomogram was developed to help physicians recognize patients with ASC.</description><identifier>ISSN: 1471-230X</identifier><identifier>EISSN: 1471-230X</identifier><identifier>DOI: 10.1186/s12876-024-03379-5</identifier><identifier>PMID: 39304833</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Acute cholangitis ; Acute Disease ; Acute suppurative cholangitis ; Adult ; Aged ; Analysis ; Antibiotics ; Antigens ; Bile ducts ; Blood ; Care and treatment ; Case-Control Studies ; Chi-square test ; Cholangitis ; Cholangitis - diagnosis ; Cholecystitis ; Diagnosis ; Diagnosis, Differential ; Disease ; Female ; Gallbladder ; Gallbladder diseases ; Humans ; Male ; Medical examination ; Medical records ; Middle Aged ; Multivariate analysis ; Nomograms ; Nomography (Mathematics) ; Patients ; Performance evaluation ; Prospective Studies ; Regression analysis ; Respiratory failure ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Severity of Illness Index ; Suppuration ; Surgery ; TG18, Nomogram</subject><ispartof>BMC gastroenterology, 2024-09, Vol.24 (1), p.322-12, Article 322</ispartof><rights>2024. The Author(s).</rights><rights>COPYRIGHT 2024 BioMed Central Ltd.</rights><rights>2024. This work is licensed under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c389t-3b3e7a4e380e7bc8e7e1f9d5b0149a7ecd2303442468f004aba7bad2de6904bf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/3115121505?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,25753,27924,27925,37012,37013,44590</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39304833$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>He, Yu-Qi</creatorcontrib><creatorcontrib>Wang, Han</creatorcontrib><creatorcontrib>Zhao, Yi-Hang</creatorcontrib><creatorcontrib>Lv, Guan-Ting</creatorcontrib><creatorcontrib>Tao, Ping</creatorcontrib><creatorcontrib>Fu, Kai</creatorcontrib><creatorcontrib>Liu, Zi-Jun</creatorcontrib><title>Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study</title><title>BMC gastroenterology</title><addtitle>BMC Gastroenterol</addtitle><description>Acute suppurative cholangitis (ASC) lacks sensitive and specific preoperative diagnostic criteria. Some researchers suggest treating ASC as severe cholangitis. This study aimed to explore the relationship between the Tokyo Guidelines 2018 (TG18) grading system for acute cholangitis (AC) and the diagnosis of acute suppurative cholangitis (ASC), searching for independent risk factors of ASC and develop a nomogram to discriminate ASC from acute nonsuppurative cholangitis (ANSC) accurately.
After applying the inclusion and exclusion criteria, 401 patients with acute cholangitis (AC) were retrospectively analyzed at Nanjing First Hospital between January 2015 and June 2023. SPSS version 27.0 and R studio software were used to analyze data obtained from medical records. The results were validated in a prospective cohort of 82 AC patients diagnosed at Nanjing First Hospital between July 2023 and February 2024.
Among the 401 patients, 102 had suppurative bile (the ASC group; AC grade I: 40 [39.2%], AC grade II: 27 [26.5%], AC grade III: 35 [34.3%]), whereas 299 did not have (the ANSC group; AC grade I: 157 [52.5%], AC grade II: 92 [30.8%], AC grade III: 50 [16.7%]). The specificity of ASC for diagnosing moderate-to-severe cholangitis is 79.7%. Multivariate logistic regression analysis identified concurrent cholecystitis, CRP, PCT, TBA, and bile duct diameter as independent risk factors for suppurative bile, and all of these factors were included in the nomogram. The calibration curve exhibited consistency between the nomogram and the actual observation, and the area under the curve was 0.875 (95% confidence interval: 0.835-0.915), sensitivity was 86.6%, and specificity was 75.5%.
Suppurative bile is a specific indicator for diagnosing moderate-to-severe cholangitis. However, diagnosing ASC with AC grade II and AC grade III has the risk of missed diagnosis as the sensitivity is only 60.8%. To improve the diagnostic rate of ASC, this study identified concurrent cholecystitis, CRP, PCT, TBA, and preoperative bile duct diameter as independent risk factors for ASC, and a nomogram was developed to help physicians recognize patients with ASC.</description><subject>Acute cholangitis</subject><subject>Acute Disease</subject><subject>Acute suppurative cholangitis</subject><subject>Adult</subject><subject>Aged</subject><subject>Analysis</subject><subject>Antibiotics</subject><subject>Antigens</subject><subject>Bile ducts</subject><subject>Blood</subject><subject>Care and treatment</subject><subject>Case-Control Studies</subject><subject>Chi-square test</subject><subject>Cholangitis</subject><subject>Cholangitis - diagnosis</subject><subject>Cholecystitis</subject><subject>Diagnosis</subject><subject>Diagnosis, Differential</subject><subject>Disease</subject><subject>Female</subject><subject>Gallbladder</subject><subject>Gallbladder diseases</subject><subject>Humans</subject><subject>Male</subject><subject>Medical examination</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Nomograms</subject><subject>Nomography (Mathematics)</subject><subject>Patients</subject><subject>Performance evaluation</subject><subject>Prospective Studies</subject><subject>Regression analysis</subject><subject>Respiratory failure</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><subject>Suppuration</subject><subject>Surgery</subject><subject>TG18, Nomogram</subject><issn>1471-230X</issn><issn>1471-230X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptks1u1TAQhSMEoqXwAixQJDZs0vo3dthVFdBKVdm0UnfWxJ4EXyXxxXYq9e3x7S0tIOSFrdE3Z85Yp6reU3JMqW5PEmVatQ1hoiGcq66RL6pDKhRtGCe3L_94H1RvUtoQQpVm_HV1wDtOhOb8sLq5CnMYI8z1EGINKfmUYcm18zAuIfllrMGuGeu0brdrhOzvsLY_wgTL6LNPn2uoLSRsbFhyDFOd8uru31avBpgSvnu8j6qbr1-uz86by-_fLs5OLxvLdZcb3nNUIJBrgqq3GhXSoXOyJ1R0oNC6Yp4LwUSrB0IE9KB6cMxh2xHRD_youtjrugAbs41-hnhvAnjzUAhxNBCztxMaYZnrOyGlwlYAA130NZVt26uWSumK1qe91jaGnyumbGafLE5lUwxrMpwSJYlUihf04z_oJqxxKZsWikrKaAGfqRHKfL8MIUewO1FzqkknmKSqK9Txf6hyHM6-fCoOvtT_amD7BhtDShGHp70pMbtcmH0uTMmFeciF2Xn58Oh47Wd0Ty2_g8B_AYYtsYM</recordid><startdate>20240920</startdate><enddate>20240920</enddate><creator>He, Yu-Qi</creator><creator>Wang, Han</creator><creator>Zhao, Yi-Hang</creator><creator>Lv, Guan-Ting</creator><creator>Tao, Ping</creator><creator>Fu, Kai</creator><creator>Liu, Zi-Jun</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7QR</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>DOA</scope></search><sort><creationdate>20240920</creationdate><title>Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study</title><author>He, Yu-Qi ; Wang, Han ; Zhao, Yi-Hang ; Lv, Guan-Ting ; Tao, Ping ; Fu, Kai ; Liu, Zi-Jun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c389t-3b3e7a4e380e7bc8e7e1f9d5b0149a7ecd2303442468f004aba7bad2de6904bf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute cholangitis</topic><topic>Acute Disease</topic><topic>Acute suppurative cholangitis</topic><topic>Adult</topic><topic>Aged</topic><topic>Analysis</topic><topic>Antibiotics</topic><topic>Antigens</topic><topic>Bile ducts</topic><topic>Blood</topic><topic>Care and treatment</topic><topic>Case-Control Studies</topic><topic>Chi-square test</topic><topic>Cholangitis</topic><topic>Cholangitis - diagnosis</topic><topic>Cholecystitis</topic><topic>Diagnosis</topic><topic>Diagnosis, Differential</topic><topic>Disease</topic><topic>Female</topic><topic>Gallbladder</topic><topic>Gallbladder diseases</topic><topic>Humans</topic><topic>Male</topic><topic>Medical examination</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Nomograms</topic><topic>Nomography (Mathematics)</topic><topic>Patients</topic><topic>Performance evaluation</topic><topic>Prospective Studies</topic><topic>Regression analysis</topic><topic>Respiratory failure</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><topic>Suppuration</topic><topic>Surgery</topic><topic>TG18, Nomogram</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>He, Yu-Qi</creatorcontrib><creatorcontrib>Wang, Han</creatorcontrib><creatorcontrib>Zhao, Yi-Hang</creatorcontrib><creatorcontrib>Lv, Guan-Ting</creatorcontrib><creatorcontrib>Tao, Ping</creatorcontrib><creatorcontrib>Fu, Kai</creatorcontrib><creatorcontrib>Liu, Zi-Jun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BMC gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>He, Yu-Qi</au><au>Wang, Han</au><au>Zhao, Yi-Hang</au><au>Lv, Guan-Ting</au><au>Tao, Ping</au><au>Fu, Kai</au><au>Liu, Zi-Jun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study</atitle><jtitle>BMC gastroenterology</jtitle><addtitle>BMC Gastroenterol</addtitle><date>2024-09-20</date><risdate>2024</risdate><volume>24</volume><issue>1</issue><spage>322</spage><epage>12</epage><pages>322-12</pages><artnum>322</artnum><issn>1471-230X</issn><eissn>1471-230X</eissn><abstract>Acute suppurative cholangitis (ASC) lacks sensitive and specific preoperative diagnostic criteria. Some researchers suggest treating ASC as severe cholangitis. This study aimed to explore the relationship between the Tokyo Guidelines 2018 (TG18) grading system for acute cholangitis (AC) and the diagnosis of acute suppurative cholangitis (ASC), searching for independent risk factors of ASC and develop a nomogram to discriminate ASC from acute nonsuppurative cholangitis (ANSC) accurately.
After applying the inclusion and exclusion criteria, 401 patients with acute cholangitis (AC) were retrospectively analyzed at Nanjing First Hospital between January 2015 and June 2023. SPSS version 27.0 and R studio software were used to analyze data obtained from medical records. The results were validated in a prospective cohort of 82 AC patients diagnosed at Nanjing First Hospital between July 2023 and February 2024.
Among the 401 patients, 102 had suppurative bile (the ASC group; AC grade I: 40 [39.2%], AC grade II: 27 [26.5%], AC grade III: 35 [34.3%]), whereas 299 did not have (the ANSC group; AC grade I: 157 [52.5%], AC grade II: 92 [30.8%], AC grade III: 50 [16.7%]). The specificity of ASC for diagnosing moderate-to-severe cholangitis is 79.7%. Multivariate logistic regression analysis identified concurrent cholecystitis, CRP, PCT, TBA, and bile duct diameter as independent risk factors for suppurative bile, and all of these factors were included in the nomogram. The calibration curve exhibited consistency between the nomogram and the actual observation, and the area under the curve was 0.875 (95% confidence interval: 0.835-0.915), sensitivity was 86.6%, and specificity was 75.5%.
Suppurative bile is a specific indicator for diagnosing moderate-to-severe cholangitis. However, diagnosing ASC with AC grade II and AC grade III has the risk of missed diagnosis as the sensitivity is only 60.8%. To improve the diagnostic rate of ASC, this study identified concurrent cholecystitis, CRP, PCT, TBA, and preoperative bile duct diameter as independent risk factors for ASC, and a nomogram was developed to help physicians recognize patients with ASC.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>39304833</pmid><doi>10.1186/s12876-024-03379-5</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Acute cholangitis Acute Disease Acute suppurative cholangitis Adult Aged Analysis Antibiotics Antigens Bile ducts Blood Care and treatment Case-Control Studies Chi-square test Cholangitis Cholangitis - diagnosis Cholecystitis Diagnosis Diagnosis, Differential Disease Female Gallbladder Gallbladder diseases Humans Male Medical examination Medical records Middle Aged Multivariate analysis Nomograms Nomography (Mathematics) Patients Performance evaluation Prospective Studies Regression analysis Respiratory failure Retrospective Studies Risk Factors Sensitivity and Specificity Severity of Illness Index Suppuration Surgery TG18, Nomogram |
title | Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study |
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