Retrospective Cohort Study
Copyright ©The Author(s) 2022.
World J Gastroenterol. Aug 7, 2022; 28(29): 3934-3945
Published online Aug 7, 2022. doi: 10.3748/wjg.v28.i29.3934
Table 1 Characteristics data for all patients
Characteristics, n (%)
Total (n = 1305)Grade I (n = 433)Grade II (n = 405)Grade III (n = 467)P value
Age (yr)-median (IQR)74 (63-82)66 (59-72.5)79 (69-84)77 (66-83)< 0.001
Male, n (%)783 (60)276 (63.7)240 (59.3)267 (57.2)0.123
CCI- median (IQR)2 (1-4)2 (1-3)2 (1-4)3 (1-5)< 0.001
Etiology, n (%)< 0.001
Choledocholithiasis906 (69.4)315 (72.7)252 (62.2)339 (72.6)
Malignant obstruction242 (18.5)73 (16.9)97 (24.0)72 (15.4)
Benign stenosis94 (7.2)27 (6.2)42 (10.4)25 (5.4)
Others63 (4.8)18 (4.2)14 (3.5)31 (6.6)
Biliary drainage, n (%)915 (70.1)302 (69.7)306 (75.6)307 (65.7)0.006
LOS (d)-median (IQR)11 (8-14)11 (8-14)11 (7.5-14)12 (7-15)0.110
Hospitalization cost (CNY)-median (IQR)38784.37 (22744.31-53278.63)36536.36 (20851.37-47274.77)38308.33 (23452.14-52847.29)41832.19 (23355.98-58145.52)< 0.001
IHM, n (%)41 (3.1)1 (0.2)7 (1.7)33 (7.1)< 0.001
Survival time of dead (d)-median (IQR)8 (3-23.5)923 (13-46)6 (3-17)0.024
Organ dysfunction
Neurological dysfunction12600126< 0.001
Respiratory dysfunction22700227< 0.001
Renal dysfunction640064< 0.001
Cardiovascular dysfunction390039< 0.001
Hematological dysfunction14900149< 0.001
Hepatic dysfunction830083< 0.001
Temperature (℃)-median (IQR)37.0 (36.6-38)36.8 (36.6-37.8)37 (36.6-38.25)37.2 (36.6-38.3)0.001
Laboratory values
WBC (/mm3)-median (IQR)10560 (7705-14305)9120 (7160-11165)12700 (8897-18441)11140 (7870-15810)< 0.001
T-Bil (mg/dL)-median (IQR)99.81 (62.43-155.76)69.28 (49.625-120.975)121.74 (88.97-184.41)1041.2 (67.74-156.31)< 0.001
Albumin (g/L)-median (IQR)35.4 (31.2-39.2)37.5 (34.2-40.4)34.9 (30.8-38.1)33.6 (29.2-37.8)< 0.001
Lactate (mmol/L)-median (IQR)2.15 (1.6-3.4)1.8 (1.4-2.7)2.1 (1.5-2.8)2.4 (1.7-4.1)< 0.001
Table 2 Characteristics data for patients with drainage
Characteristics, n (%)
Total (n = 915)
Grade I (n = 302)
Grade II (n = 306)
Grade III (n = 307)
P value
Drainage method, n (%)0.001
ERCP830 (90.7)289 (95.7)269 (87.9)272 (88.6)
PTBD85 (9.3)13 (4.3)37 (12.1)35 (11.4)
Timing of drainage (hours)- median (IQR), n (%)24.0 (60.0)26.4 (62.4)26.4 (62.4)21.6 (45.6)0.001
Biliary drainage within, n (%)0.001
12 h212 (23.2)54 (17.9)69 (22.5)89 (29.0)
12-24 h233 (25.5)74 (24.5)70 (22.9)89 (29.0)
24-48 h172 (18.8)71 (23.5)54 (17.6)47 (15.3)
> 48 h298 (32.6)103 (34.1)113 (36.9)82 (26.7)
Second intervention, n (%) 478 (52.2)159 (52.6)154 (50.3)165 (53.7)0.688
Drainage outside working hours, n (%)207 (22.6)49 (16.2)60 (19.6)98 (31.9)< 0.001
Adverse events, n (%)
Pancreatitis75 (8.2)23 (7.6)23 (7.5)29 (9.4)0.643
Cholangitis8 (0.9)2 (0.7)2 (0.7)4 (1.3)0.742
Perforation 7 (0.8)1 (0.3)2 (0.7)0 (0)0.440
Bile leak 4 (0.4)2 (0.7)1 (0.3)1 (0.3)0.701
Myocardial infarction5 (0.5)0 (0)3 (1.0)2 (0.7)0.339
Table 3 Association of the clinical outcomes in relation to the timing of biliary drainage and severity grading by Tokyo guidelines 2018
Severity of AC
Characteristic-median (IQR)
Drainage
Absence of drainage
P value
Drainage < 12 h
Drainage > 12 h or absence
P value
Drainage < 24 h
Drainage > 24 h or absence
P value
Drainage < 48 h
Drainage > 48 h or absence
P value
Grade IIHM0/3021/1310.3030/541/3791.000 0/1281/3051.000 0/1991/2341.000
LOS (d) 11 (9-15)7 (4-10)< 0.00111 (8-13.25)10 (8-14)0.778 11 (8-14)10 (7-14)0.00411 (8-14)10 (6-14)0.002
Survivors’ LOS (d) (n = 387)12 (9-15)8 (5-11)< 0.00111 (8-13.25)11 (8-14)0.794 11 (9-14)11 (8-14)0.065 11 (9-14)10 (8-14)0.101
Hospitalization cost (CNY) 42845.67 (33734.18-52209.23)15763.10 (7737.32-23680.31) < 0.00143328.59 (32863.61-49384.19)35317.71 (18848.59-46850.08 0.001 44154.19 (35638.76-52219.56) 31292.68 (16269.75-44599.67) < 0.001 42908.34 (33358.44-50564.68)25519.43 (12347.06-42424.96)< 0.001
Survivors’ hospitalization cost (CNY) (n = 387)42957.18 (33973.58-52224.73)16596.85 (9096.73-24755.65 < 0.00143462.72 (36174.00-49384.19)36604.86 (21962.98-47554.27) 0.003 44443.3 (35988.02-52237.14) 33492.6 (46019.17-18880.26) < 0.001 43264.07 (34606.54-51093.62)29762.32 (16376.75-44463.21)< 0.001
Grade IIIHM2/3065/990.0110/697/3360.608 0/1397/2660.101 1/1936/2120.125
LOS (d) 11 (9-15)7 (4-12)< 0.00111 (8-14)11 (7-14)0.68411 (9-14)10 (7-14)0.12211 (8-14)10 (7-14.8)0.190
Survivors’ LOS (d) (n = 349)12 (9-15)7.5 (4.75-11.25)< 0.00111.5 (9-14)11 (8-14)0.36712 (10-14)11 (7-14)0.02412 (9-14)11 (7-14)0.050
Hospitalization cost (CNY)44033.13 (31071.05-56134.72) 17626.20 (10037.69-25587.43)< 0.00145832.44 (36061.53-56949.37) 36132.93 (21795.89-51453.62) < 0.001 46789.09 (35989.59-57723.15) 31505.72 (19948.31-47463.61) < 0.001 45489.74 (33858.99-57600.43)29275.30 (16928.45-46255.47)< 0.001
Survivors’ hospitalization cost (CNY) (n = 349)45004.20 (32631.09-56660.62) 16342.15 (10300.68-25017.80)< 0.00147938.00 (37937.29-58046.02) 36629.15 (22828.93-51509.37) < 0.001 48254.61 (37937.29-58929.51) 31589.96 (20386.80-47062.76) < 0.001 46564.37 (36191.07-57998.63)29338.38 (17687.02-45685.12)< 0.001
Grade IIIIHM11/30722/160< 0.0013/8930/3780.168 7/17826/2890.041 9/22524/2420.018
LOS (d) 13 (9-17)8 (3-12)< 0.00113 (11-19)11 (6-15)< 0.001 13 (10-17)10 (6-14)< 0.001 13 (9-17)9.5 (5-14)< 0.001
Survivors’ LOS (d) (n = 351)13 (11-18)9.5 (7-13.25)<0.00113 (12-19)12 (9-16)0.001 13 (11-17.75)12 (9-15)< 0.001 13 (11-17.75)11 (8-15)< 0.001
Hospitalization cost 51583.64 (38985.47-64886.01) 20183.58 (11317.37-29525.99) < 0.00156599.94 (43260.73-70300.00) 38527.58 (21034.79-55279.53) < 0.001 55121.49 (40428.29-67707.01) 31832.99 (17933.81-50037.89) < 0.001 54295.52 (39252.57-65638.57)28165.23 (15708.29-45478.26)< 0.001
Survivors’ hospitalization cost (CNY) (n = 351)53507.33 (41027.94-65312.29) 22909.77 (15594.93-31845.39) < 0.00157976.4 (50131.44-70333.71) 43241.54 (28347.56-57860.29) < 0.001 55873.84 (46654.40-69946.73) 38973.06 (24292.41-53090.85) < 0.001 55782.38 (43994.26-66493.67)34748.29 (21379.37-50147.24)< 0.001
Table 4 Univariate and multivariate analysis of predictors of mortality, and relationship of mortality with the timing of drainage for each predictor
Predictors (n = 1305)Univariate analysis
Multivariate analysis
Mortality to the timing of drainage
OR (95%CI)
P value
OR (95%CI)
P value
< 12 h
> 12 h or absence
P value
< 24 h
> 24 h or absence
P value
< 48 h
> 48 h or absence
P value
Neurological dysfunction8.377 (4.384-16.007)< 0.0015.32 (2.373-11.931)< 0.0010/2218/1040.0413/4215/840.1755/5113/750.304
Respiratory dysfunction2.886 (1.491-5.497)0.0032.541 (1.189-5.43)0.0161/4414/1830.3144/9111/1360.4146/1179/1100.428
Renal dysfunction11.043 (5.402-22.573)< 0.0016.356 (2.623-15.397)< 0.0011/1512/490.2691/2812/360.0041/3112/330.001
Cardiovascular dysfunction11.569 (5.078-26.357)< 0.0014.021 (1.361-11.88)0.0120/79/320.1692/167/230.2622/187/210.139
Hematological dysfunction2.611 (1.253-5.441)0.02N/A2/378/10413/617/880.5273/747/750.327
Hepatic dysfunction5.263 (2.484-11.152)< 0.001N/A0/1510/680.1961/309/530.0861/399/440.016
Age (≥ 75 yr)1.432 (0.765-2.680)0.261N/A2/8821/5310.7594/19619/4230.1727/26716/3520.284
Temperature (≥ 39 ℃)0.390 (0.093-1.631)0.197N/A0/432/10611/751/7411/851/641
WBC (> 12000/mm3, < 4000/mm3)1.962 (1.043-3.688)0.036N/A1/10723/4450.0634/20720/3420.0316/27818/2750.012
T-Bil (≥ 5 mg/dL)1.711 (0.865-3.385)0.123N/A3/14326/6260.3335/29224/4770.0198/40721/3620.007
Albumin (< STD*0.7)10.715 (5.147-22.303)< 0.0015.655 (2.398-13.335)< 0.0010/812/510.1880/1512/440.0261/2411/350.018
Lactate (≥ 2 mmol/L) 1.450 (0.766-2.747)0.254N/A0/10516/2980.0162/18614/2170.0084/22712/1760.018
Malignant obstruction5.495 (2.924-10.325)< 0.0017.522 (3.504-16.149)< 0.0011/2621/2160.4832/5920/1830.1163/10119/1410.006
CCI (> 3)4.080 (2.153-7.7340)< 0.001N/A2/5723/3180.3974/12721/2480.0526/17719/1980.021