Predictive factors for developing acute cholangitis due to choledocholithiasis

Abstract

Abstract Background Acute cholangitis, an acute and severe disease in the clinic, is mostly caused by choledocholithiasis. This study aimed to identify the predictive factors for developing acute cholangitis due to choledocholithiasis. Methods A total of 558 patients with choledocholithiasis were enrolled. The patients were divided into a choledocholithiasis group (n = 399) and an acute cholangitis group (n = 159) according to whether they had acute cholangitis. The clinical data were analyzed, and logistic regression was used to predict acute cholangitis. Receiver operating characteristic (ROC) curves were generated to identify predictive factors for acute cholangitis. Results The acute cholangitis group had a greater prevalence of male sex, age ≥ 70 years, smoking history, hypertension, fever (> 38°C) and/or shaking chills, duodenal peripapillary diverticulum, and maximum diameter of choledocholithiasis (≥ 10 mm). Furthermore, the acute cholangitis group had higher WBC, CRP, T-Bil, ALT, AST, ALP, GGT, serum creatinine (Scr), prothrombin time (PT) and D-dimer (D-D) levels and lower albumin levels. Logistic regression analysis revealed that the maximum diameter of choledocholithiasis (≥ 10 mm), T-Bil, CRP, WBC, fever (> 38°C) and/or shaking chills, male sex, AST, and ALP were independent risk factors for developing acute cholangitis, with an area under the ROC curve (AUC) of 0.869 for CRP, 0.858 for T-Bil, 0.835 for WBC, 0.765 for AST and 0.743 for ALP. Conclusions Attention should be given to choledocholithiasis patients who have a maximum diameter of choledocholithiasis (≥ 10 mm), T-Bil > 34.25 µmol/L, CRP > 10.85 mg/L, WBC > 9.95×109/L, fever (> 38℃) and/or shaking chills, male sex, ALP > 162.5 U/L and AST > 57.8 U/L. Interventions may be taken to prevent acute cholangitis.