title: Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage.
abstract: OBJECTIVE
  To prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD).
  
  
  METHODS
  Institutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF.
  
  
  RESULTS
  Fourteen (14.4%) patients developed IF and 17 (17.5%) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95% CI 2.658-1510.055; P = 0.010) and low INR (OR 4.7 × 10(-4); 95% CI 0.000-0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95% CI 1.161-17.992; P = 0.030).
  
  
  CONCLUSIONS
  The amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. pierleone.lucatelli@gmail.com.
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.affiliation: Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Stefano Ginanni
authors.initials: SG
authors.lastname: Corradini
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Corona
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Luca Ginanni
authors.initials: LG
authors.lastname: Corradini
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cirelli
authors.affiliation: Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Saba
authors.affiliation: Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Poli
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
authors.affiliation: Department of Vascular Interventional Radiology of the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Haofan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Bezzi
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
mesh_terms: D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000379:methods; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005334:Fever / Q000209:etiology*; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Bile duct dilatation; Contrast media volume; Fever; Percutaneous transhepatic biliary drainage; Unsatisfactory biliary drainage