Acute cholangitis in intensive care units: ...
Document type :
Article dans une revue scientifique: Article original
Title :
Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study
Author(s) :
Lavillegrand, Jean-Rémi [Auteur]
Mercier-Des-Rochettes, Emmanuelle [Auteur]
Baron, Elodie [Auteur]
Pène, Frédéric [Auteur]
Contou, Damien [Auteur]
Favory, Raphael [Auteur]
Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]
Préau, Sébastien [Auteur]
Galbois, Arnaud [Auteur]
Molliere, Chloé [Auteur]
Miailhe, Arnaud-Félix [Auteur]
Reignier, Jean [Auteur]
Monchi, Mehran [Auteur]
Pichereau, Claire [Auteur]
Thietart, Sara [Auteur]
Vieille, Thibault [Auteur]
Piton, Gael [Auteur]
Preda, Gabriel [Auteur]
Abdallah, Idriss [Auteur]
Camus, Marine [Auteur]
Maury, Eric [Auteur]
Guidet, Bertrand [Auteur]
Dumas, Guillaume [Auteur]
Ait-Oufella, Hafid [Auteur]
Mercier-Des-Rochettes, Emmanuelle [Auteur]
Baron, Elodie [Auteur]
Pène, Frédéric [Auteur]
Contou, Damien [Auteur]
Favory, Raphael [Auteur]

Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]
Préau, Sébastien [Auteur]
Galbois, Arnaud [Auteur]
Molliere, Chloé [Auteur]
Miailhe, Arnaud-Félix [Auteur]
Reignier, Jean [Auteur]
Monchi, Mehran [Auteur]
Pichereau, Claire [Auteur]
Thietart, Sara [Auteur]
Vieille, Thibault [Auteur]
Piton, Gael [Auteur]
Preda, Gabriel [Auteur]
Abdallah, Idriss [Auteur]
Camus, Marine [Auteur]
Maury, Eric [Auteur]
Guidet, Bertrand [Auteur]
Dumas, Guillaume [Auteur]
Ait-Oufella, Hafid [Auteur]
Journal title :
Critical Care
Pages :
49
Publisher :
BioMed Central
Publication date :
2021-02-06
ISSN :
1364-8535
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Abstract Background Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Methods Retrospective multicenter study included adults ...
Show more >Abstract Background Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Methods Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis. Results Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients ( n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] ( p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12–1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones ( p < 0.05) and AC complications (OR 2.74 [95% CI 1.45–5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02). Conclusions In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.Show less >
Show more >Abstract Background Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Methods Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis. Results Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients ( n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] ( p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12–1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones ( p < 0.05) and AC complications (OR 2.74 [95% CI 1.45–5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02). Conclusions In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.Show less >
Language :
Anglais
Peer reviewed article :
Oui
Audience :
Internationale
Popular science :
Non
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