Analysis Of Risk Factors For Severe Acute Cholangitis Based On TG18/TG13

Objective In the present study,we aimed to analyze the clinical characteristics of patients with acute cholangitis(AC)and to investigate the independent risk factors for severe AC based on TG18/TG13,which may provide guidance for clinical diagnosis and treatment.Methods Patients discharged with the first diagnosis of acute cholangitis were retrospectively collected in the First Affiliated Hospital of Soochow University from January 2013 to June 2018.General characteristics,clinical data,imaging findings,prognosis and other necessary data were recorded.The diagnostic value of TG18/TG13,2007 Tokyo Guidelines(TG07)and Charcot triad was evaluated.The independent risk factors of severe AC and the value of these risk factors in predicting 30-day mortality were analyzed.Results A total of 347 AC patients were included in this study,among which 176(50.7%)were male patients and 299(86.2%)were patients with bile duct stones as the etiology.A diagnosis of acute cholangitis was made in 156(45.0%)patients on the basis of the Charcot triad,in 260(74.9%)patients on the basis of the TG07,and in 284(81.8%)patients based on TG18/TG13.Obviously,more patients with suspected AC could be diagnosed based on TG18/TG13 than Charcot triad and TG07,with statistically significant difference(p<0.001).AC was classified as mild in 141(40.6%),moderate in 91(26.2%)and severe in 115(33.1%)according to TG18/TG13 severity assessment criteria.There was no death in the mild to moderate group,but 16(13.9%)in the severe group.The difference between the two groups was statistically significant(p<0.001).Binary Logistic regression analysis showed that a history of smoking(OR=4.64,p<0.001),the prothrombin time international standardization odds ratio(PT-INR)?1.2(OR=3.47,p=0.003),higher calcitonin(PCT)(OR=1.18,p<0.001),higher creatinine(Cr)(OR=2.40,p=0.015),lower albumin(ALB)(OR=0.30,p=0.001)were independent risk factors for severe AC.ROC curve showed that the above five factors could predict the 30 day mortality rate of patients.Cr,PT-INR and ALB had strong predictive power,with the area under the curve(AUC)being 0.80,0.77 and 0.75,respectively.However,smoking history and PCT had weaker predictive power,with the AUC being 0.63 and 0.68,respectively.The value of the new model consisting of the above five factors in predicting 30-day mortality in AC patients was not significantly different from that of TG18/TG13(p=0.14).Conclusion TG18/TG13 can better identify suspected AC patients.Patients with a history of smoking,PT-INR?1.2,higher PCT,higher Cr and lower ALB were more likely to develop severe AC.The above five factors could better predict the 30-day mortality of AC patients.