Risk factors and incidence of acute pyogenic cholangitis
Yun-Sheng Qin, Qi-Yong Li, Fu-Chun Yang and Shu-Sen Zheng
Hangzhou, China

BACKGROUND: Acute cholangitis varies from mild to severe
form. Acute suppurative cholangitis (ASC), the severe form of
acute cholangitis, is a fatal disease and requires urgent biliary
decompression. Which patients are at a high risk of ASC and
need emergency drainage is still unclear. The present study
aimed to identify the factors for determining early-stage ASC
and distinguishing ASC from acute cholangitis.
METHODS: We analyzed 359 consecutive patients with acute
cholangitis who had been admitted to the First Affiliated
Hospital, Zhejiang University School of Medicine from
January 2004 to May 2011. Emergency endoscopic retrograde
cholangiopancreatography (ERCP) was carried out in all patients
to decompress or clear the stones by experienced endoscopists.
Clinical and therapeutic data were collected, and univariate and
multivariate analyses were performed to identify the potential
risk factors of ASC.
RESULTS: Of the 359 patients, 1 was excluded because of failure
of ERCP drainage. Of the remaining 358 patients with an
average age of 62.7 years (range 17-90), 162 were diagnosed with
ASC, and 196 with non-ASC. ENBD catheters were placed in 343
patients (95.8%), of whom 182 patients had stones removed at
the same time, and plastic stent was placed in 25 patients (7.0%).
Clinical conditions were improved quickly after emergency
biliary drainage in all patients. Complications were identified in
11 patients (3.1%): mild pancreatitis occurred in 8 patients and
hemorrhage in 3 patients. There was no mortality. Univariate
analysis showed that several variables were associated with ASC:
age, fever, decreased urine output, hypotension, tachycardia,
abnormal white blood cell count (WBC), low platelet, high C
reactive protein (CRP), and duration of the disease. Multivariate analysis revealed that advanced age, hypotension, abnormal
WBC, high CRP, and duration of the disease were independent
risk factors for ASC.
CONCLUSIONS: This study demonstrates that advanced age,
hypotension, abnormal WBC, high CRP, and long duration of
antibiotic therapy are significantly associated with ASC. We
recommend decompression by ERCP should be carried out in
patients as early as possible.
(Hepatobiliary Pancreat Dis Int 2012;11:650-654)