Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

• Published in: Critical care (London, England) England), 2021-02, Vol.25 (1), p.49-49, Article 49
• Main Authors: Lavillegrand, Jean-Rémi, Mercier-Des-Rochettes, Emmanuelle, Baron, Elodie, Pène, Frédéric, Contou, Damien, Favory, Raphael, Préau, Sébastien, Galbois, Arnaud, Molliere, Chloé, Miailhe, Arnaud-Félix, Reignier, Jean, Monchi, Mehran, Pichereau, Claire, Thietart, Sara, Vieille, Thibault, Piton, Gael, Preda, Gabriel, Abdallah, Idriss, Camus, Marine, Maury, Eric, Guidet, Bertrand, Dumas, Guillaume, Ait-Oufella, Hafid
• Format: Article
• Language: English
• Subjects: Bacterial infections; Bile; Cholangitis; Clinical outcomes; Complications and side effects; Critical care; Critically ill; Gallbladder diseases; Health risks; Inflammatory diseases; Intensive care; Intensive care unit; Life Sciences; Medical prognosis; Microbiology; Mortality; Outcome; Patient outcomes; Prognosis; Risk factors; Statistics
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-021-03480-1

Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis. Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5-11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50-147] and 19.1 µg/L [5.3-54.8]. Sixty-three percent of patients (n  = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54-0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05-1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08-1.36], by 1 mmol/L, p