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Acute cholangitis—predictive factors for emergency ERCP
Author(s) -
Hui C.K.,
Lai K.C.,
Yuen M.F.,
Ng M.,
Lai C.L.,
Lam S.K.
Publication year - 2001
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2001.01071.x
Subject(s) - medicine , prospective cohort study , emergency department , prothrombin time , gastroenterology , psychiatry
Background: Acute cholangitis varies in severity from a mild form to severe cases which require urgent biliary decompression. Aim: This study was undertaken in order to develop a prognostic scoring system that can be used to predict which patients are likely to require emergency endoscopic retrograde cholangiopancreatogram (ERCP) upon admission. Methods: This is a prospective study of 142 consecutive patients with acute cholangitis. Emergency ERCP was performed in patients who did not respond to medical therapy. Results: Thirty‐one patients (21.8%) required emergency ERCP. A maximum heart rate of more than 100/min, albumin of less than 30 g/L, bilirubin of more than 50 μmol/L and prothrombin time of more than 14 s on admission were associated with failure of medical treatment and the need for emergency ERCP ( P =0.001, < 0.001, 0.006 and 0.004, respectively). By using these four factors in a scoring system, 50.7% of those with a score of one or more required emergency ERCP compared with 1.5% of those with none of the four risk factors ( P < 0.001). This scoring system has a sensitivity of 96.8% and a specificity of 59.6%. Conclusions: As patients with severe acute cholangitis show a higher mortality, we recommend that emergency ERCP be performed in patients with one or more of the four prognostic factors.