Mortality Risk for Acute Cholangitis (MAC): A risk prediction model for in-hospital mortality in patients with acute cholangitis

Schneider, John E.; Hapfelmeier, A; Thöres, Sieglinde; Obermeier, Andreas; Schulz, Céline; Nennstiel, Simon; Spinner, Christoph D.; Pförringer, Dominik; Huber, W.; Schmid, R; Algül, Hana; Weber, Andrew T.

doi:10.1055/s-0035-1559101

Cited by 14 publications

(20 citation statements)

References 19 publications

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“…Regarding the outcomes among patients with acute cholangitis, our study provides updated and comprehensive data for overall mortality and complications among patients with acute cholangitis. The previously available data have been only from single or few institutions and may not have reflected true mortality for a long period of time [10,14]. Our data demonstrated the mortalities increased along with the severity grades and this reflects validity of the TG13 severity assessment [1].…”

Section: Discussionmentioning

confidence: 58%

Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis

Gomi

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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Background The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG07) and revised in 2013 (TG13). This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time. Methods This is an international multi-center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis by clinicians between 1 January 2011 and 31 December 2012 were enrolled. Those who met the diagnostic criteria of acute cholangitis by TG13 were statistically analyzed. Results A total of 7,294 patients were enrolled and 6,433 patients met the TG13 diagnostic criteria. The severity distribution was Grade I (37.5%), Grade II (36.2%), and Grade III (26.2%). The 30-day all-cause mortality was 2.4%, 4.7%, and 8.4% in Grade I, II, III severity, respectively (P < 0.001). The incidence of liver abscess and endocarditis as complications of acute cholangitis was 2.0% and 0.26%, respectively. Conclusions This is the first large scale study to investigate patients with acute cholangitis. This study provides the basis to define the best practices to manage patients with acute cholangitis in future studies.

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Section: Discussionmentioning

confidence: 58%

Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis

Gomi

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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“…The entire literature on TG13 severity grading criteria consisted of four case series studies , again illustrating the paucity of research in this area.…”

Section: Severity Grading Criteria For Acute Cholangitismentioning

confidence: 99%

“…However, no correlation between severity grading and 30‐day mortality was observed in patients with AC caused by malignant tumors . One of the problems with the TG13 severity grading criteria is that the Grade III prognostic factors are all assigned the same weight, which has resulted in univariate analysis identifying “disturbance of consciousness” as the most important predictor of risk . In the multicenter study in Japan and Taiwan, the Grade III prognostic factors (other than hepatic dysfunction) shown by multivariate analysis to be significant all had roughly equal weights.…”

Section: Severity Grading Criteria For Acute Cholangitismentioning

confidence: 99%

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Kiriyama

Kozaka

Takada

et al. 2018

J Hepato Biliary Pancreat

503

425

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Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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“…While study from Ito T et al, in Asia in 2016, the average age in patients with cholangitis was 68.76±14.58. [7][8][9] In this study, the incidence of cholangitis in females was higher 43 patients (66.2%) compared with male 22 patients (33.8%). Although this is inconsistent with the incidence of Tokyo guidelines 2013 which states the incidence of cholangitis between male and female is the same.…”

Section: Discussionmentioning

confidence: 44%

Evaluation of acute physiology and chronic health evaluation IV predictive scoring as mortality predictor among individual with cholangitis

et al. 2018

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Background: Evaluation of the effectiveness of care and clinical outcomes in critically ill patients is dependent on predictive scoring models that calculate measures of disease severity and mortality. Cholangitis is an infection and obstruction of the biliary system. The APACHE IV scoring system is a logistic regression model incorporating physiologic and laboratory parameters. APACHE IV is the most updated scoring system for Intensive Care Unit (ICU) mortality prediction.Methods: A cohort study with 65 cholangitis patient that fulfilled diagnostic criteria of Tokyo guideline 2013 was included. The APACHE IV score was assessed during first day admission to ICU. APACHE IV score and predicted mortality rate was calculated and evaluated using the area under the ROC curve (AUROC).Results: Overall in-hospital mortality was 26.2 %. The APACHE IV score mean was 76.7 with the highest score was 133 point. AUROC of the APACHE IV score was 0.97 with the cut point of 0.87, 95% CI (0.94, 0.91) indicating good performance in this cohort.Conclusions: APACHE IV scoring system has good discrimination in the prediction of mortality models for cholangitis patients.

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Mortality Risk for Acute Cholangitis (MAC): A risk prediction model for in-hospital mortality in patients with acute cholangitis

Cited by 14 publications

References 19 publications

Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis

Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)

Evaluation of acute physiology and chronic health evaluation IV predictive scoring as mortality predictor among individual with cholangitis

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