Prognostic factors of acute cholangitis in cases managed using the Tokyo Guidelines

In 2007, the Tokyo Guidelines (TG07) working group established diagnostic criteria for assessment of the severity of acute cholangitis. This study aimed to analyze outcomes and identify predictors of mortality in patients with acute cholangitis managed according to the TG07.

In this study, 215 consecutive cases of acute cholangitis were reviewed. Risk factors associated with mortality or refractory cholangitis, which is defined on the basis of prolonged hospitalization (>28 days) or disease resulting in fatality, were examined using multivariate logistic regression analysis.

There were 52, 133, and 30 cases of mild, moderate, and severe cholangitis, respectively. The overall mortality rate was 4.2 % (9/215). Mortality rates in patients with mild, moderate, and severe cholangitis were 0, 2.3, and 20.0 %, respectively (moderate vs. severe, p = 0.001). Multivariate analysis showed that serum albumin levels ≤2.8 g/dl and PT-INR >1.5 were significant predictors of mortality. There were 57 patients (26.5 %) with refractory cholangitis. Multivariate analysis showed that serum albumin level ≤2.8 g/dl, PT-INR >1.5, etiology and inpatient status were significant predictors of refractory cholangitis.

The TG07 severity assessment criteria for acute cholangitis were significantly predictive of mortality. Hypoalbuminemia is an important risk factor in addition to organ dysfunction.