Acute cholangitis--predictive factors for emergency ERCP.
BACKGROUND
Acute cholangitis varies in severity from a mild form to severe cases which require urgent biliary decompression.


OBJECTIVE
This study was undertaken in order to develop a prognostic scoring system that can be used to predict which patients are likely to require emergency endoscopic retrograde cholangiopancreatogram (ERCP) upon admission.


METHODS
This is a prospective study of 142 consecutive patients with acute cholangitis. Emergency ERCP was performed in patients who did not respond to medical therapy.


RESULTS
Thirty-one patients (21.8%) required emergency ERCP. A maximum heart rate of more than 100/min, albumin of less than 30 g/L, bilirubin of more than 50 micromol/L and prothrombin time of more than 14 s on admission were associated with failure of medical treatment and the need for emergency ERCP (P=0.001, < 0.001, 0.006 and 0.004, respectively). By using these four factors in a scoring system, 50.7% of those with a score of one or more required emergency ERCP compared with 1.5% of those with none of the four risk factors (P < 0.001). This scoring system has a sensitivity of 96.8% and a specificity of 59.6%.


CONCLUSIONS
As patients with severe acute cholangitis show a higher mortality, we recommend that emergency ERCP be performed in patients with one or more of the four prognostic factors.
Hui
C K
CK
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Lai
K C
KC
Yuen
M F
MF
Ng
M
M
Lai
C L
CL
Lam
S K
SK
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000032:analysis; D001663:Bilirubin / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D019299:Decompression, Surgical; D004630:Emergencies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011517:Prothrombin Time; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000418:Albumins; D001663:Bilirubin