Abnormal pre-drainage serum creatinine as a prognostic indicator in acute cholangitis

Two hundred and twenty-five patients diagnosed as having non-malignant acute cholangitis were studied to evaluate the incidence and prognostic significance of pre-drainage acute renal failure. Thirty-seven patients (16.4%) were found to have serum creatinine greater than, or equal to, 1.5 mg/dl before the drainage procedure. The risk factors for impaired renal function evaluated by multivariate analysis were advanced age, low albumin, low globulin, and clinical presentation of Charcot's triad or Reynold's pentad. The mortality rate in the abnormal pre-drainage serum creatinine group was 21.6%, which was much higher than the mortality (3.7%) seen in the normal serum creatinine group (p less than 0.0001). The other risk factors of mortality evaluated by multivariate analysis were the bilirubin level, combined common bile duct stones and intrahepatic duct stones, and bile duct stricture. We conclude that abnormal pre-drainage serum creatinine is not an uncommon finding in acute cholangitis. It is of prognostic significance, and should be considered as important as the clinical findings of Reynold's pentad.