Characteristics and clinical outcomes of acute cholangitis in older patients

Acehan, Fatih; Çamlı, Hüseyin; Kalkan, Çağdaş; Tez, Mesut; Altıparmak, Emin; Ateş, İhsan

doi:10.1007/s41999-023-00763-4

Cited by 2 publications

(5 citation statements)

References 35 publications

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“…In agreement with previous studies, this study revealed that while the elderly patients had a much more severe disease than the non-elderly patients [3,12], the percentage of in-hospital mortality and ICU admission in the elderly group was not significantly higher than that in the non-elderly group [5,6]. The prognosis of elderly patients with acute cholangitis is expected to be poorer than that of younger patients, similar to most other severe illnesses, because the association of advanced age with mortality in patients with acute cholangitis has already been demonstrated in several studies [3,13,14].…”

Section: Discussionsupporting

confidence: 92%

“…For example, an international multicenter study similarly noted that old age (≥75 years) did not significantly correlate with 30-day mortality (OR 1.35 (95% CI 0.98-1.88)) [11]. In addition, recent studies from China and Turkey revealed that mortality rates in acute cholangitis patients did not differ between the elderly and the non-elderly [5,6]. These results indicate that developing surrogate markers of frailty other than age is essential to predict the prognosis of acute cholangitis more precisely before overt organ failure.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, age is often used in severity classification as a surrogate marker for comorbidities and functional capacity [5]; thus, those aged 75 years or over are classified as Grade II (moderate) severity as per the TG18 [4]. However, the number of studies on the prognosis of acute cholangitis in patients aged 75 years or older is limited [3,6,10,11]. In addition, studies explicitly comparing the clinical outcomes of acute cholangitis due to choledocholithiasis are rare [5].…”

Section: Discussionmentioning

confidence: 99%

“…Another reason for the low mortality rate is that we excluded acute cholangitis resulting from malignancy because acute cholangitis due to malignant biliary obstruction has a poorer prognosis [17]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…Despite this, it is necessary to compare disease severity and clinical outcomes between elderly and non-elderly patients with acute cholangitis to establish a customized treatment strategy for elderly patients because it remains controversial whether age itself is the deciding factor in adverse outcomes for acute cholangitis. Recent studies from China and Turkey found no difference in mortality rates between elderly (≥80 years) and non-elderly (<80 years) patients with acute cholangitis [5,6]. However, a study from Turkey found that the mortality rate for those with acute cholangitis over 80 years of age was significantly higher than that of those younger than 80 [3].…”

Section: Introductionmentioning

confidence: 99%

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

Lee,

Cheon

et al. 2023

Medicina

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Background and Objectives: Acute cholangitis may be fatal, particularly in elderly patients. According to the Tokyo Guidelines 2018, those aged ≥75 years are classified as moderate (Grade II) severity. However, it has not been established whether age itself is the deciding factor of poor outcomes. We studied the impact of old age (≥75 years) on the mortality and morbidity of acute cholangitis due to choledocholithiasis. Materials and Methods: We retrospectively examined 260 patients with calculous acute cholangitis who had undergone biliary drainage. Patients were divided into two groups: elderly (≥75 years) and non-elderly (<75 years). We aimed to compare organ dysfunction, in-hospital mortality, intensive care unit (ICU) hospitalization, and the severity of acute cholangitis. Results: Of 260 patients, 134 (51.5%) were in the elderly group and 126 (48.5%) were in the non-elderly group. The mean age was 72.3 ± 14.4 years, and 152 (58.5%) were men. The elderly patients showed a higher incidence of shock (12.7% vs. 4.8%, p = 0.029), respiratory dysfunction (7.5% vs. 0%, p = 0.002), and renal dysfunction (8.2% vs. 0.8%, p = 0.006) than the non-elderly patients. The overall in-hospital mortality rate was 2.7%, with no significant differences between the elderly and the non-elderly (4.5% vs. 0.8%, p = 0.121). The incidence of severe acute cholangitis was significantly higher in the elderly group (26.9% vs. 9.5%, p < 0.001). However, there was no significant difference in the rates of ICU hospitalization (9.7% vs. 4%, p = 0.088) and lengths of hospital stay (LOS) (8.3 d vs. 7.1 d, p = 0.086). Conclusions: No difference was observed in the in-hospital mortality, ICU hospitalization, or LOS between the elderly (≥75 years) and the non-elderly (<75 years) with calculous acute cholangitis. However, severe acute cholangitis was significantly more frequent in elderly patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Lee,

Cheon

et al. 2023

Medicina

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Clinical Features and Prognosis of Acute Cholangitis in Octogenarians: A Prospective Comparative Study

Comoglu,

Acehan,

Sahiner

et al. 2024

Medicina

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Background: The data on acute cholangitis in the octogenarian population are very limited. This study aimed to examine the clinical characteristics of acute cholangitis and complications related to endoscopic retrograde cholangiopancreatography (ERCP) in octogenarians. Materials and Methods: This study was conducted prospectively between July 2022 and December 2023 and included 250 patients aged 65 years and older. Patients eligible for the study were divided into two groups: those aged ≥80 years (octogenarian) and those aged 65–79 years (non-octogenarian). These two groups were compared in terms of the clinical characteristics of cholangitis and ERCP-related complications. In addition, factors associated with in-hospital mortality were evaluated. Results: Out of 250 patients, 87 (34.8%) were octogenarians and 163 (65.2%) were non-octogenarians. The median age was 76 (69–82) years. Although the octogenarian group had higher rates of severe illness and intensive care unit admissions (p < 0.001 and p = 0.002, respectively), there were no significant differences in in-hospital mortality (p = 0.359) or ERCP-related complications (p = 0.417). Malignant etiology (odds ratio [OR]: 5.68, 95% confidence interval [CI]: 2.11–15.3), hypoalbuminemia (OR 0.18, 95% CI 0.07–0.45), and qSOFA score ≥ 2 (OR: 6.5, 95% CI: 1.7–24.5) were independent risk factors for in-hospital mortality. Conclusions: Being over 80 years old is not an indicator of poor outcomes, and ERCP can be safely performed on these patients. However, elderly patients with hypoalbuminemia, malignant etiology, or a qSOFA score of ≥2 should be closely monitored, regardless of their age.

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Characteristics and clinical outcomes of acute cholangitis in older patients

Cited by 2 publications

References 35 publications

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

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

Clinical Features and Prognosis of Acute Cholangitis in Octogenarians: A Prospective Comparative Study

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