title: Factors involved in resistance to early treatment of acute cholangitis patients.
abstract: OBJECTIVE
  Severity-based treatment is not homogenously effective for acute cholangitis patients and some are resistant to early treatment. We performed a retrospective cohort study involving acute cholangitis patients and analyzed factors strongly associated with resistance to early treatment.
  
  
  METHODS
  The subjects were 94 patients admitted to the Department of Gastroenterology, Showa University Hospital and diagnosed with acute cholangitis. The endpoint was set as the presence or absence of resistance to early treatment. Background and blood test results of the patients immediately after admission were surveyed and significant factors independently contributing to resistance to early treatment were extracted from the surveyed factors employing a logistic regression model.
  
  
  RESULTS
  The mean age of the patients was 73.2 ± 11.6 years and 58 were male (61.7%). Jaundice, fever and abdominal pain were observed in 46 (48.9%), 66 (70.2%) and 85 patients (90.4%), respectively. Twenty-eight patients (29.8%) were resistant to early treatment. On multivariate analysis, 3 factors (fever, serum amylase level and systolic blood pressure (below 100 mm Hg)) were extracted as significant factors independently contributing to resistance to early treatment (p<0.05).
  
  
  CONCLUSIONS
  If such resistance can be predicted before treatment, appropriate treatment may be selected to shorten the persistence of symptoms, improving the patient's QOL.
authors.affiliation: Health Service Center, School of Medicine, Showa University, Tokyo, Japan. yoneyama@med.showa-u.ac.jp
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Yoneyama
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Saito
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kurihara
authors.forename: Mari
authors.initials: M
authors.lastname: Kogo
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kitamura
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Iwata
authors.forename: Michiro
authors.initials: M
authors.lastname: Imawari
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kiuchi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016009:Chi-Square Distribution; D002761:Cholangitis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D015415:Biomarkers; D000681:Amylases