Clinical Predictors of Worsening in Non-severe Acute Cholangitis

Objective Risk factors for progression from non-severe to severe acute cholangitis (AC) remain unclear. This study aimed to identify predictors of disease progression with a particular focus on the prognostic nutritional index (PNI). Methods We retrospectively analyzed 239 patients with Grade I or II AC who underwent endoscopic biliary drainage within 24 h of hospital presentation. The patients were classified into 2 groups: progression (n=18) and non-progression (n=221). The clinical characteristics were compared between the two groups. Results The progression group had a higher proportion of Grade II AC (83.3% vs. 47.5%, p=0.006) and received immunosuppressive therapy more frequently (27.8% vs. 5.9%, p=0.006) but had a lower PNI (36.67 vs. 39.81, p=0.003) than the non-progression group. The proportion of patients with low PNI (<38) was significantly higher in the progression group than in the non-progression group (66.6% vs. 37.6%, p=0.023). In addition, the mortality rate was significantly higher in the progression group than in the non-progression group (11.1% vs. 0.9%, p=0.029). Conclusion Progression to severe AC may be associated with Grade II AC, immunosuppressive therapy, and a low PNI. Even after early biliary drainage, patients presenting with these conditions require close clinical monitoring.