Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2022; 28(29): 3934-3945
Published online Aug 7, 2022. doi: 10.3748/wjg.v28.i29.3934
Optimal timing of biliary drainage based on the severity of acute cholangitis: A single-center retrospective cohort study
Zhao-Qing Lu, Han-Yu Zhang, Chen-Fen Su, Yue-Yan Xing, Guo-Xing Wang, Chun-Sheng Li
Zhao-Qing Lu, Han-Yu Zhang, Chen-Fen Su, Yue-Yan Xing, Guo-Xing Wang, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Chun-Sheng Li, Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Li CS designed the research study and made critical revisions to the article; Lu ZQ, Zhang HY, Xing YY, Su CF, and Wang GX performed the research and analyzed the data; Lu ZQ drafted the article; all authors have read and approved the final manuscript.
Institutional review board statement: This retrospective cohort study was conducted according to the tenets of the Declaration of Helsinki, and approved by the Bioethics Committee of Beijing Friendship Hospital, Capital Medical University (Certification No. 2020-P2-224-01).
Informed consent statement: Since we conducted a retrospective review of patient data obtained from the electronic medical records of our hospital, and as stated by the ethical standards of China, the Ethics Committee exempted the need for obtaining informed consent.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The datasets used during the current study are available from the corresponding author on reasonable request at lcscyyy@163.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Sheng Li, PhD, Professor, Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. lcscyyy@163.com
Received: March 17, 2022
Peer-review started: March 17, 2022
First decision: April 11, 2022
Revised: April 25, 2022
Accepted: July 5, 2022
Article in press: July 5, 2022
Published online: August 7, 2022
ARTICLE HIGHLIGHTS
Research background

Acute cholangitis (AC) is a life-threatening condition that occurs in the presence of biliary obstruction. Biliary decompression is well known to greatly decrease the risks of mortality in AC. Although early biliary drainage is recommended by the treatment guidelines for AC, the exact timeframe is yet to be established.

Research motivation

We have observed that the clinical outcomes of severe AC patients vary dramatically. So, we first attempted to study whether AC patients with different organ dysfunction should undergo biliary drainage at distinct times and try to screen out patients that could benefit the most from earlier drainage.

Research objectives

To investigate the optimal drainage timing for AC patients with each disease severity grade and organ dysfunction.

Research methods

In this retrospective monocenter cohort analysis, we reviewed 1305 patients who were diagnosed with AC according to the Tokyo guidelines 2018 at a Chinese tertiary hospital for four years. We investigated the all-cause in-hospital mortality (IHM), hospital length of stay (LOS), and hospitalization costs associated with the timing of biliary drainage according to the severity grading and different dysfunctioning organs and critical predictors [age, white blood cell (WBC) count, total bilirubin, albumin, lactate, malignant obstruction, and Charlton comorbidity index (CCI)].

Research results

Biliary drainage within 24 h in Grade III AC patients had the greatest benefit, which could significantly reduce the all-cause IHM, while increasing LOS and hospitalization costs. Multivariate logistic analysis revealed that neurological, respiratory, renal, and cardiovascular dysfunctions, hypoalbuminemia, and malignant obstruction were significantly associated with IHM. Furthermore, AC patients complicated with neurological dysfunction or with serum lactate > 2 mmol/L should be drained as early as possible (< 12 h) for it could significantly decrease the IHM. In the subgroup of AC patients with renal dysfunction, abnormal WBC count, hyperbilirubinemia, or hypoalbuminemia, drainage within 24 h reduced the IHM, while in the subgroup of AC patients with hepatic dysfunction, malignant obstruction, or a CCI > 3, biliary drainage should be performed within 48 h.

Research conclusions

Biliary drainage within 12 h is beneficial for AC patients with neurological or cardiovascular dysfunction, while complete biliary decompression within 24 h of admission is recommended for treating patients with Grade III AC.

Research perspectives

A further multicenter prospective cohort study will be conducted to verify the result and investigate whether the optimal timing of drainage based on different organ dysfunctions can increase the 30-d mortality rates and decrease the readmission rate.