Proportion of Neutrophils in the White Blood Cells as a Useful Marker for Predicting Bacteremic Acute Cholangitis

Abstract

Background A positive hemoculture in acute cholangitis is serious, and accordingly, a predictor for bacteremia at initial diagnosis would be particularly useful. We investigated the association between neutrophil proportion in the white blood cell count (Neut%) and bacteremic acute cholangitis. Methods In 166 patients of acute cholangitis diagnosed with Tokyo guideline 2013 from April 2014 to March 2015, ninety-four patients underwent blood culture assessment and were divided into a positive hemoculture (n = 48) and negative hemoculture (n = 46) group and these two group were compared. A receiver operating characteristic curve analysis was used to evaluate the predictive ability of Neut% and other inflammatory markers. Results Neut% was significantly higher in the positive hemoculture (91.7 ± 4.0% vs. 82.5 ± 9.0%, P < 0.0001). A cutoff Neut% value of 89.7% was strongly associated with bacteremia (area under the curve 0.86, sensitivity 77%, specificity 80%). A Neut% of ≥ 89.7% was a predictor of positive hemoculture in the univariate (P < 0.0001) and multivariate analyses (P < 0.001). Patients with a Neut% ≥89.7% needed early biliary drainage (30/46, 65.2% vs. 18/48, 37.5%, P = 0.0063). Conclusions Neut% is an independent predictor of bacteremia and prognosis in patients with acute cholangitis and may contribute to decision-making of early biliary drainage.