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Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study.

Yu-Qi He1, Han Wang2, Yi-Hang Zhao1

  • 1Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, No. 919 Yingtian Street, Jianye District, Nanjing, Jiangsu Province, 210000, China.

BMC Gastroenterology
|September 20, 2024
PubMed
Summary
This summary is machine-generated.

This study developed a nomogram to accurately diagnose acute suppurative cholangitis (ASC) by identifying key risk factors. The tool aims to improve diagnostic rates for ASC, especially in moderate-to-severe cases.

Keywords:
Acute cholangitisAcute suppurative cholangitisTG18, Nomogram

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Area of Science:

  • Hepatology and Gastroenterology
  • Surgical Diagnostics
  • Medical Informatics

Background:

  • Acute suppurative cholangitis (ASC) diagnosis lacks specific preoperative criteria.
  • Current guidelines may misclassify ASC, suggesting it be treated as severe cholangitis.
  • There is a need for improved diagnostic tools for ASC.

Purpose of the Study:

  • To evaluate the Tokyo Guidelines 2018 (TG18) for grading acute cholangitis (AC).
  • To identify independent risk factors for ASC.
  • To develop a predictive nomogram for differentiating ASC from acute nonsuppurative cholangitis (ANSC).

Main Methods:

  • Retrospective analysis of 401 AC patients (January 2015 - June 2023).
  • Prospective validation cohort of 82 AC patients (July 2023 - February 2024).
  • Statistical analysis using SPSS and R studio, including multivariate logistic regression.

Main Results:

  • Multivariate analysis identified concurrent cholecystitis, CRP, PCT, TBA, and bile duct diameter as independent risk factors for ASC.
  • A nomogram incorporating these factors demonstrated good calibration and an AUC of 0.875.
  • The nomogram achieved 86.6% sensitivity and 75.5% specificity in predicting ASC.

Conclusions:

  • Suppurative bile is a specific indicator for moderate-to-severe cholangitis.
  • Current AC grading systems have limitations in diagnosing ASC, with a sensitivity of 60.8% for grades II and III.
  • The developed nomogram offers a valuable tool for improving ASC diagnosis by incorporating key clinical and laboratory parameters.