title: Mortality Risk for Acute Cholangitis (MAC): a risk prediction model for in-hospital mortality in patients with acute cholangitis.
abstract: BACKGROUND
  Acute cholangitis is a life-threatening bacterial infection of the biliary tract. Main focus of this study was to create a useful risk prediction model that helps physicians to assign patients with acute cholangitis into different management groups.
  
  
  METHODS
  981 cholangitis episodes from 810 patients were analysed retrospectively at a German tertiary center.
  
  
  RESULTS
  Out of eleven investigated statistical models fit to 22 predictors, the Random Forest model achieved the best (cross-)validated performance to predict mortality. The receiver operating characteristics (ROC) curve revealed a mean area under the curve (AUC) of 91.5 %. Dependent on the calculated mortality risk, we propose to stratify patients with acute cholangitis into a high and low risk group. The mean sensitivity, specificity, positive and negative predictive value of the corresponding optimal cutpoint were 82.9 %, 85.1 %, 19.0 % and 99.3 %, respectively. All of these results emerge from nested (cross-)validation and are supposed to reflect the model's performance expected for external data. An implementation of our risk prediction model including the specific treatment recommendations adopted from the Tokyo guidelines is available on http://www2.imse.med.tum.de:3838/ .
  
  
  CONCLUSIONS
  Our risk prediction model for mortality appears promising to stratify patients with acute cholangitis into different management groups. Additional validation of its performance should be provided by further prospective trails.
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. jochen.schneider@tum.de.
authors: Jochen
authors: J
authors: Schneider
authors: Institute of Medical Statistics and Epidemiology, Technische Universität München, München, Germany. alexander.hapfelmeier@tum.de.
authors: Alexander
authors: A
authors: Hapfelmeier
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. sieglinde.thoeres@tum.de.
authors: Sieglinde
authors: S
authors: Thöres
authors: Klinik für Orthopädie, Labor für Infektionsforschung, Klinikum rechts der Isar, Technische Universität München, München, Germany. andreas.obermeier@tum.de.
authors: Andreas
authors: A
authors: Obermeier
authors: Institut für klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, Technische Universität München, München, Germany. christoph.schulz@tum.de.
authors: Christoph
authors: C
authors: Schulz
authors: I. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. dominik.pfoerringer@tum.de.
authors: Dominik
authors: D
authors: Pförringer
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. simon.nennstiel@tum.de.
authors: Simon
authors: S
authors: Nennstiel
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. christoph.spinner@tum.de.
authors: Christoph
authors: C
authors: Spinner
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. roland.schmid@tum.de.
authors: Roland M
authors: RM
authors: Schmid
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. hana.alguel@tum.de.
authors: Hana
authors: H
authors: Algül
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. wolfgang.huber@tum.de.
authors: Wolfgang
authors: W
authors: Huber
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany. andreas.weber@mri.tum.de.
authors: Andreas
authors: A
authors: Weber
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002761:Cholangitis / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity