Early predictors of in-hospital mortality after percutaneous cholecystostomy
1Department of Interventional Radiology, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Elazig Road, 10th km Uçkuyular Location, Diyarbakir, Kayapınar, 21070, Turkey.
Background:
Acute cholecystitis is a common cause of emergency surgical admission, particularly among elderly and medically complex patients. Percutaneous cholecystostomy (PC) is frequently used as a minimally invasive treatment option for patients considered unsuitable for early cholecystectomy. However, factors associated with in-hospital mortality and the impact of radiologic disease burden after PC remain incompletely characterized.
Methods:
We conducted a retrospective single-center cohort study including consecutive adult patients who underwent image-guided PC for acute cholecystitis between January 2022 and December 2025. Clinical, laboratory, procedural, and radiologic variables were analyzed. Factors associated with in-hospital mortality were evaluated using multivariable logistic regression analysis. An exploratory radiologic severity score (RSS) was constructed using predefined imaging findings including pericholecystic fluid, gallbladder perforation, emphysematous cholecystitis, and gallbladder wall thickness ≥ 7 mm. Associations between RSS and inflammatory response following PC were also assessed.
Results:
A total of 266 patients were included (mean age 64.9 ± 17.1 years; 56.4% male). The overall in-hospital mortality rate was 7.5% (n = 20). Factors independently associated with in-hospital mortality included older age (OR, 2.06 per 10-year increase, 95% CI, 1.25-3.39), malignancy (OR, 9.19, 95% CI, 2.71-31.22), elevated LDH (OR, 1.86 per 100 U/L increase, 95% CI, 1.23-2.81), and higher post-procedural day-3 CRP levels (OR, 2.17 per 50 mg/L increase, 95% CI, 1.32-3.55). The multivariable model demonstrated good discriminative performance in internal validation (cross-validated AUC: 0.895). Higher RSS values were associated with reduced CRP decline following PC (p = 0.041), suggesting slower inflammatory resolution. However, RSS was not significantly associated with mortality or hospital length of stay.
Conclusion:
In this retrospective cohort, in-hospital mortality after percutaneous cholecystostomy was primarily associated with baseline patient vulnerability and persistent early inflammatory response after the intervention. Radiologic disease burden appeared to correlate with inflammatory recovery rather than mortality. Given the retrospective design, limited number of mortality events, and lack of external validation, these findings should be considered exploratory and hypothesis-generating. Prospective multicenter studies are warranted to further validate these observations.
