Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?

Abstract

Time series analysis is a valuable tool in epidemiology that complements the classical epidemiological models in two different ways: Prediction and forecast. Prediction is related to explaining past and current data based on various internal and external influences that may or may not have a causative role. Forecasting is an exploration of the possible future values based on the predictive ability of the model and hypothesized future values of the external and/or internal influences. The time series analysis approach has the advantage of being easier to use (in the cases of more straightforward and linear models such as Auto-Regressive Integrated Moving Average). Still, it is limited in forecasting time, unlike the classical models such as Susceptible-Exposed-Infectious-Removed. Its applicability in forecasting comes from its better accuracy for short-term prediction. In its basic form, it does not assume much theoretical knowledge of the mechanisms of spreading and mutating pathogens or the reaction of people and regulatory structures (governments, companies, etc. ). Instead, it estimates from the data directly. Its predictive ability allows testing hypotheses for different factors that positively or negatively contribute to the pandemic spread; be it school closures, emerging variants, etc. It can be used in mortality or hospital risk estimation from new cases, seroprevalence studies, assessing properties of emerging variants, and estimating excess mortality and its relationship with a pandemic.

Imaging features of malignant vs stone-induced biliary obstruction: Aspects to consider

“…As expected, patients with biliary obstruction of malignant origin have a significantly worse clinical course compared to those with lithiasic obstruction of the bile duct, present a higher incidence of severe acute cholangitis, greater admission to critical care units, and 30-d mortality, as recently reported by Tsou et al [ 4 ], which underscores the importance of being able to differentiate the origin of biliary obstruction during the imaging study.…”

“…In summary, when conducting radiological evaluations of patients with bile duct obstruction, comprehensive consideration should be given to various imaging findings, with a focus on analyzing important imaging information. Considering the clinical implication of these diseases, I hope the discussion on the interesting articles by Tsou et al [ 4 ]. and Aydin and Irgul[ 1 ] will promote the permanent ongoing review of the imaging features of malignant and stone-induced bile duct obstruction to further improve the early recognition and appropriate management of these patients.…”

The Comparison of Clinical Outcomes in Elderly (≥75 Years) and Non-Elderly (<75 Years) Patients with Acute Cholangitis Due to Choledocholithiasis

“…Acehan et al reported that the malignant etiology was an independent risk factor for in-hospital mortality in patients with acute cholangitis [6]. Tsou et al also reported that 30-day mortality was significantly higher in the malignant biliary obstruction group than in the choledocholithiasis group (5.4% vs. 0.7%, p = 0.045) among 516 patients with acute cholangitis [18].…”

Response letter to “Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the outcomes?” with imaging aspects

“…We were intrigued by the paper “Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?” by Tsou et al [ 1 ]. This study primarily examined laboratory data to distinguish between malignant biliary obstruction and obstruction caused by stones and underscored it’s significance.…”