Clinical and biochemical factors for bacteria in bile among patients with acute cholangitis

Acute cholangitis is a clinical syndrome caused by a bacterial infection in the biliary system. The bacteria could exist in the bile before bile drainage despite empirical antibiotic treatment.

Patients with acute cholangitis admitted to a tertiary hospital in Southeastern China from August 2011 to September 2021 were involved when bile cultures were performed. Patient information before bile cultures and during hospitalization was extracted from the clinical record database. The risk factors related to bacteria in bile were assessed by univariable and multivairable logistic regression analysis, respectively.

A total of 533 patients (66.05%) had bacterial growth in bile. Alanine aminotransferase concentration [odds ratio (OR) = 0.998, P  < 0.001], absolute monocyte count (OR = 0.335, P  = 0.001), and duration of antibiotic use (OR = 0.933, P  = 0.026) were negatively correlated with bacteria in bile. In contrast, C-reactive protein (OR = 1.006, P  = 0.003), thrombin time (OR = 1.213, P  = 0.033), prothrombin time (OR = 1.210, P  = 0.011), and age (OR = 1.025, P  < 0.001) were positively correlated with bacteria in bile. Based on an area under the receiver operating characteristic curve of 0.737 (95% CI, 0.697-0.776, P  < 0.001), combining these seven variables could efficiently predict the presence of bacteria in bile among patients with acute cholangitis.

The combination of clinical indicators before bile drainage could predict the risk of bacteria in bile for patients with acute cholangitis.