Risk Factors Analysis And Prediction Models Establishment Of Post Endoscopic Retrograde Cholangiopancreatography Acute Choleycystitis In Patients With Chronic Gallbladder Disease

Background: Endoscopic retrograde cholangiopancreatography（ERCP）is a minimally invasive method widely used to diagnose and treat diseases of the biliary and pancreatic systems,which may lead to some postoperative complications,such as postERCP pancreatitis（PEP）,perforation,bleeding and post-ERCP cholecystitis（PEC）,The majority of studies on post-ERCP complications at this stage focus on PEP with a higher incidence,and there are relatively few related studies due to the low incidence of PEC.Previous studies have found that most of the patients who develop PEC have chronic gallbladder disease preoperatively,and for such patients,the risk of postoperative PEC will be greatly increased due to abnormal preoperative gallbladder status.PEC will not only affect life quality,but also be an important factor affecting the prognosi,so it is necessary to further study the risk factors of PEC in patients with preoperative chronic gallbladder disease on the basis of previous studies.Objective: To analyze the risk factors of PEC in patients with chronic gallbladder disease,establish nomogram prediction model for assessing the risk of PEC in patients with preoperative combined chronic gallbladder disease and to implement preventive measures.Methods: Detailed clinical data of patients treated with ERCP for common bile duct stones at the First Hospital of Lanzhou University from January 2010 to December2019 were collected retrospectively according to inclusion and exclusion criteria.Risk factors for PEC were analyzed using Cox proportional risk regression models,receiver operating characteristic（ROC）curves were plotted to assess the predictive efficacy of the models,and the independent risk factors obtained from Cox regression were incorporated into R software to establish column line graph prediction models,calibration curves were used to verify the accuracy of the model.Results: A total of 491 eligible patients were included,including 76 patients with PEC and 415 patients without PEC.Cox univariate analysis showed that preoperative white blood cell count（HR=1.136,95%CI: 1.095-1.180）,AST（HR=1.001,95%CI:1.000-1.001）,ALT（HR=1.001,95%CI: 1.000-1.002）,TBIL（HR=1.003,95%CI: 1.001-1.005）,DBIL（HR=1.004,95%CI: 1.002-1.007）,preoperative blood glucose level（HR=1.100,95%CI: 1.000-1.001）,endoscopic sphincter audi balloon dilation（EPBD）（HR=1.863,95%CI: 1.160-2.993）,ERBBD（HR=3.175,95%CI: 1.957-5.152）,mechanical lithotriptomy（HR=2.541,95%CI: 1.557-4.415）,intraoperative gallbladder imaging（HR=4.025,95%CI: 2.505-6.467）and postoperative bile duct stone residue（HR=3.648,95%CI: 2.326-5.723）were the influencing factors of PEC（P < 0.05）.Multivariate analysis showed preoperative white blood cell count（HR=1.110,95%CI:1.062-1.160）,ERBD（HR=2.810,95%CI: 1.651-4.753）,intraoperative gallbladder imaging（HR=2.856,95%CI: 1.745-4.675）and postoperative bile duct stone residue（HR=1.775,95%CI: 1.070-2.947）were independent risk factors for developing PEC within 6 months after surgery（P < 0.05）.The ROC curve was plotted by combining the above four independent risk factors,and the area under the curve（AUC）was 0.830（95%CI: [0.768,0.893]）.Conclusion: Preoperative white blood cell count,ERBD,intraoperative gallbladder imaging,and postoperative bile duct stone residue were independent risk factors for the occurrence of PEC within 6 months after ERCP in patients with chronic gallbladder disease.The established prediction model was used to evaluate the risk of PEC in patients with chronic gallbladder disease before surgery,and the results showed that the model had good predictive efficiency.