Incidence, risk factors, and prognosis of acute kidney injury in hospitalized patients with acute cholangitis

Abstract

Background The association between acute cholangitis (AC) and acute kidney injury (AKI) remains unclear. We investigated the incidence, and clinical course of AKI in patients with AC, and the long-term prognosis. Methods We performed a single-center retrospective study of patients hospitalized with AC in a tertiary care center from January 2011 to December 2017. The risk factors for AKI were evaluated, and AKI severity was analyzed using the Systemic Inflammatory Response System (SIRS), quick sequential organ failure assessment (qSOFA) score, and 2018 Tokyo Guidelines (TG) grade. To calculate the relative risk of death based on AKI, hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using Cox’s proportional hazard models. Results A total of 1,438 patients with AC were included, of whom 18.2% (n = 261) developed AKI. AKI patients were older, and had a lower systolic blood pressure and more comorbidities including hypertension (HT), chronic kidney disease, and cardiovascular accidents. Disease severity (as assessed by SIRS, qSOFA, and the Tokyo Guidelines grade) was higher in the AKI group, as was the in-hospital mortality rate. Multivariate analysis revealed that age, HT, SIRS and qSOFA scores ≥ 2, and TG grade of III were significant risk factors for AKI. Kaplan-Meier analysis revealed significantly higher mortality in the AKI than non-AKI group. AKI (HR = 1.853; 95% CI: 1.115–3.079) and TG grade III (HR = 2.139; 95% CI: 1.190–3,846) were independent predictors of all-cause AC mortality, even after adjusting for all covariates. The annual rate of decline in the estimated glomerular filtration rate was faster in the AKI than non-AKI group (2.9 ± 6.7 vs. 0.5 ± 5.3 mL/min/1.73 m2/year, p < 0.001). Conclusions AKI development increased AC severity and mortality. Our results suggest that clinicians should monitor AKI status and perform appropriate management as soon as possible.

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

“…Therefore, the attending physician may have preferred PTBD because it is considered to be less invasive and does not require moderate sedation/general anesthesia [5]. Consistently with previous studies [20,21], elevated creatinine levels were associated with acute cholangitis mortality in our study. Elsewhere, a French study reported that the SOFA score (OR 1.14, 95% CI 1.05-1.24) was associated with the in-hospital mortality of patients admitted to the ICU with acute cholangitis [22].…”

Analysis of Pathogenic Bacteria Distribution and Related Factors in Recurrent Acute Cholangitis

“…AKI (HR = 1.853, 95% CI = 1.115–3.079) was an independent predictor of all-cause acute cholangitis mortality. 38 Our results confirmed that chronic kidney disease was also identified as possible independent risk factors for recurrence of acute cholangitis. The effect of acute kidney injury and chronic kidney injury on recurrence of acute cholangitis remains to be further explored.…”

Percutaneous cholecystostomy in acute complicated versus uncomplicated cholecystitis; is there a difference in outcomes? A single-center experience

“…Most of these patients are unwell and dehydrated on admission due to sepsis, which is a risk factor for developing AKI. The association of AKI with high mortality in patients with acute cholangitis has been recently published as an independent predictor for mortality, highlighting the importance of early recognition and treatment (10). However, there is a paucity of data demonstrating this in patients with acute cholecystitis undergoing PC.…”