title: Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis.
abstract: BACKGROUND
  The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG07) and revised in 2013 (TG13). This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time.
  
  
  METHODS
  This is an international multi-center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis by clinicians between 1 January 2011 and 31 December 2012 were enrolled. Those who met the diagnostic criteria of acute cholangitis by TG13 were statistically analyzed.
  
  
  RESULTS
  A total of 7,294 patients were enrolled and 6,433 patients met the TG13 diagnostic criteria. The severity distribution was Grade I (37.5%), Grade II (36.2%), and Grade III (26.2%). The 30-day all-cause mortality was 2.4%, 4.7%, and 8.4% in Grade I, II, III severity, respectively (P < 0.001). The incidence of liver abscess and endocarditis as complications of acute cholangitis was 2.0% and 0.26%, respectively.
  
  
  CONCLUSIONS
  This is the first large scale study to investigate patients with acute cholangitis. This study provides the basis to define the best practices to manage patients with acute cholangitis in future studies.
authors.affiliation: Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Gomi
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.affiliation: Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan.
authors.forename: Tsann-Long
authors.initials: TL
authors.lastname: Hwang
authors.affiliation: Department of medical informatics, Niigata University, Niigata, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Akazawa
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.affiliation: Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan.
authors.forename: Seiki
authors.initials: S
authors.lastname: Kiriyama
authors.affiliation: Department of Infection Control and Prevention, Teikyo University, Tokyo, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Matsunaga
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Yokoe
authors.affiliation: Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan.
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
authors.affiliation: Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan.
authors.forename: Yi-Yin
authors.initials: YY
authors.lastname: Jan
authors.affiliation: Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan.
authors.forename: Chen-Guo
authors.initials: CG
authors.lastname: Ker
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.affiliation: Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
authors.affiliation: Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D002761:Cholangitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D038622:Internationality; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute cholangitis; Epidemiology; Microbiology; Mortality