Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

Critical Care

Elodie Baron¹  Frédéric Pène¹  Sara Thietart²  Eric Maury³  Bertrand Guidet³  Guillaume Dumas³  Jean-Rémi Lavillegrand⁴  Hafid Ait-Oufella⁴  Damien Contou⁵  Claire Pichereau⁶  Gael Piton⁷  Thibault Vieille⁷  Idriss Abdallah⁸  Raphael Favory⁹  Sébastien Préau⁹  Gabriel Preda^1,10  Mehran Monchi^1,11  Emmanuelle Mercier-Des-Rochettes^1,11  Arnaud-Félix Miailhe^1,12  Jean Reignier^1,12  Chloé Molliere^1,13  Arnaud Galbois^1,13  Marine Camus^1,14 

[1] Assistance Publique – Hôpitaux de Paris (AP-HP), Service de médecine intensive et réanimation, Hôpital Cochin, 75014, Paris Cedex 12, France;Assistance Publique – Hôpitaux de Paris (AP-HP), Service de médecine intensive et réanimation, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France;Assistance Publique – Hôpitaux de Paris (AP-HP), Service de médecine intensive et réanimation, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France;Sorbonne Université, Paris, France;Assistance Publique – Hôpitaux de Paris (AP-HP), Service de médecine intensive et réanimation, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France;Sorbonne Université, Paris, France;Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France;Centre Hospitalier Argenteuil, Service de réanimation polyvalente et unité de surveillance continue, 95107, Argenteuil, France;Centre Hospitalier Intercommunal Poissy Saint-Germain-en-Laye, Service de réanimation, Hôpital de Poissy, 78303, Poissy, France;Centre Hospitalier Régional Universitaire Besançon, Service de réanimation médicale, Hôpital Jean Minjoz, 25030, Besançon, France;Centre Hospitalier Sud Seine-et-Marne, Service de réanimation, Hôpital Fontainebleau, 77300, Fontainebleau, France;Centre Hospitalier Universitaire Lille, Service de réanimation générale, Hôpital Salengro, 59037, Lille, France;Centre Hospitalier de Saint-Denis, Service de réanimation et soins continus, Hôpital Delafontaine, 93205, Saint-Denis, France;Groupe Hospitalier Sud Île-De-France (GHSIF), Service de réanimation polyvalente, Hôpital de Melun-Sénart, 77000, Melun, France;Service de médecine intensive et réanimation, Centre Hospitalier Universitaire Nantes, Hôtel-Dieu, 44000, Nantes, France;Service de réanimation polyvalente, Hôpital Privé Claude Galien, 91480, Quincy-sous-Sénart, France;Sorbonne Université, Paris, France;Assistance Publique – Hôpitaux de Paris (AP-HP), Centre d’endoscopie digestive, Hôpital Saint-Antoine, Paris, France;

关键词: Cholangitis;    Outcome;    Prognosis;    Microbiology;    Intensive care unit;   

DOI  :  10.1186/s13054-021-03480-1

来源: Springer

【 摘 要 】

BackgroundLittle is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC).MethodsRetrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis.ResultsOverall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients (n  = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12–1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones (p < 0.05) and AC complications (OR 2.74 [95% CI 1.45–5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02).ConclusionsIn this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.

【 授权许可】

CC BY