The Risk Factors For Acute Cholangitis Of Severe Type Caused By Bile Duct Stones

Background:Choledocholithiasis is one of the most prevalent gastroenterological diseases,with good prognosis generally. If it causes acute suppurative cholangitis(ASC),known as acute cholangitis of severe type(ACST), it will easily lead to a variety of serious complications such as sepsis, septic, multiple organ dyfunction syndrome,which usually develop quickly and threat to patient's life. Thus, it is necessary to early diagnose and carry out an effective intervention therapy.Objective:Our purpose is to analyse the related risk factors for ACST caused by common bile duce stones, so as to early predict the appearance of ACST. And it will help to choose the most appropriate treatment options for clinicians.Methods:From January 2015 to December 2015, the patients in Gastroenterology Departmentr of the First Affiliated Hospital, Nanchang University, were enrolled.They were diagnosed with acute cholangitis caused by common bile duct(CBD)stones. According to whether with ACST, they were divided into two groups: ACST and non ACST. We investigated their hospital informations retrospectively.Univariate analyses and multivariate analyses were used to compare data of the two groups and identify the risk factors associated with ACST. Besides, the ROC curve was used to analyse the thresholds of the related indices associated with ACST.Results:1. We had collected 388 cases of patients with acute cholangitis, 12 patients were ruled out because of without underwenting ERCP or failure of ERCP drainage. 376 patients were enrolled. Among them, 172 patients were diagnosed with ACST(men83, women 89), the average age was 64.2±15.2 years(range 19-93years), 204 patients non ACST(men 106, women 98), the average was 64.9±15.0 years(range18-92years). Univariate analysis of the two groups:(1) cliniaca data: advanced age(>70 years), smoking, T>39.0?, history of biliary tract surgery, duodenal papilladiverticulun, gallbladder stones, impacted bile-duct stones, the diameter of the largest stone>1.5 cm had statistical significance(P<0.05).(2) The comparision of inspection data analysis showed that the ALT, AST, TBIL, DBIL, ALB, PLT, PT, the counts of WBC and N% had particularly statistical significance(P<0.0001). the value of ALT,AST, TBIL, DBIL, PT, the counts of WBC and N% in ACST group were significantly higher than the non ACST group, but the value of PLT and ALB in ACST group was lower than the non ACST group.2. Backward stepwise logistic regression analysis found that advanced age(>70years), impacted bile-duct stones, history of biliary tract surgery, WBC, TBIL,smoking were positive correlation with ACST(P<0.05), and the regression coefficient were 2.034, 1.889, 1.470, 0.989, 0.941, 0.728 respectively, while the Odds ratio(OR) were 7.644, 6.609, 4.350, 2.687, 2.563, 2.071 respectively.3. The ROC curve analysis indicated that When TBIL>79.9mmol/L,WBC>12×109/L(P<0.0001), the patients who were diagnosed with acute cholangitis were at the most risk in ACST, the sensitivity were 73.3% and 64.0% respectively,and the specificity were 80.9% and 75.0% respectively.4. All patients underwent ERCP to remove stones or reduce biliary pressure. 4(2.3%) post-ERCP complications had been found in ACST(1 gastrointestinal bleeding, 3 mild acute pancreatitis) and 5(2.5%) complications in non ASC(gastrointestinal bleeding in 1 patient, mild pancreatitis in 2 patients and high blood amylases in 2 patients). The clinical conditions(jaundice, pain at right upper quadrant,fever, hypotension or disturbed consciousness) were significantly relieved after 72 h ERCP in patients with ACST, meanwhile the results of liver function and blood routine were improved obviously, which had statistical significance(P<0.001).Conclusions:1. This study demonstrates that advanced age(>70 years), impacted bile duct stones, history of biliary tract surgery, smoking are independent risks for ACST caused by common bile duce stones.2. The value of TBIL, WBC are main predictive indices for ACST. And when TBIL>79.9mmol/L, WBC>12×109/L, it predicts that patients who are diagnosed with acute cholangitis are at the most risk of developing to ACST.3. Early prediction of ACST will be conductive to choose effective treatment for clinicians, and ERCP is regard as the preferred minimally invasive trerapeutic method.