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Validation of Tokyo Guidelines 2007 and Tokyo Guidelines 2013/2018 Criteria for Acute Cholangitis and Predictors of In-Hospital Mortality
Visceral Medicine ( IF 1.9 ) Pub Date : 2021-06-08 , DOI: 10.1159/000516424
Ramkumar Mohan 1 , Stefanie Wei Lynn Goh 2 , Guan Wei Tan 2 , Yen Pin Tan 3 , Sameer P Junnarkar 3 , Cheong Wei Terence Huey 1, 3 , Jee Keem Low 3 , Vishal G Shelat 1, 3
Affiliation  

Background: Acute cholangitis (AC) is a common emergency with a significant mortality risk. The Tokyo Guidelines (TG) provide recommendations for diagnosis, severity stratification, and management of AC. However, validation of the TG remains poor. This study aims to validate TG07, TG13, and TG18 criteria and identify predictors of in-hospital mortality in patients with AC. Methods: This is a retrospective audit of patients with a discharge diagnosis of AC in the year 2016. Demographic, clinical, investigation, management and mortality data were documented. We performed a multinomial logistic regression analysis with stepwise variable selection to identify severity predictors for in-hospital mortality. Results: Two hundred sixty-two patients with a median age of 75.9 years (IQR 64.8–82.8) years were included for analysis. TG13/TG18 diagnostic criteria were more sensitive than TG07 diagnostic criteria (85.1 vs. 75.2%; p #x3c; 0.006). The majority of the patients (n = 178; 67.9%) presented with abdominal pain, pyrexia (n = 156; 59.5%), and vomiting (n = 123; 46.9%). Blood cultures were positive in 95 (36.3%) patients, and 79 (83.2%) patients had monomicrobial growth. The 30-day, 90-day, and in-hospital mortality numbers were 3 (1.1%), 11 (4.2%), and 15 (5.7%), respectively. In multivariate analysis, type 2 diabetes mellitus (OR = 12.531; 95% CI 0.354–116.015; p = 0.026), systolic blood pressure #x3c;100 mm Hg (OR = 10.108; 95% CI 1.094–93.395; p = 0.041), Glasgow coma score #x3c;15 (OR = 38.16; 95% CI 1.804–807.191; p = 0.019), and malignancy (OR = 14.135; 95% CI 1.017–196.394; p = 0.049) predicted in-hospital mortality. Conclusion: TG13/18 diagnostic criteria are more sensitive than TG07 diagnostic criteria. Type 2 diabetes mellitus, systolic blood pressure #x3c;100 mm Hg, Glasgow coma score #x3c;15, and malignant etiology predict in-hospital mortality in patients with AC. These predictors could be considered in acute stratification and treatment of patients with AC.
Visc Med


中文翻译:

东京指南 2007 和东京指南 2013/2018 急性胆管炎标准和住院死亡率预测指标的验证

背景:急性胆管炎 (AC) 是一种常见的急症,具有显着的死亡风险。东京指南 (TG) 为 AC 的诊断、严重程度分层和管理提供了建议。然而,TG 的验证仍然很差。本研究旨在验证 TG07、TG13 和 TG18 标准,并确定 AC 患者住院死亡率的预测因子。方法:这是对 2016 年出院诊断为 AC 的患者的回顾性审计。记录了人口、临床、调查、管理和死亡率数据。我们使用逐步变量选择进行多项逻辑回归分析,以确定住院死亡率的严重程度预测因子。结果:包括 262 名中位年龄为 75.9 岁(IQR 64.8-82.8)岁的患者进行分析。TG13/TG18 诊断标准比 TG07 诊断标准更敏感(85.1 对 75.2%;p #x3c;0.006)。大多数患者(n = 178;67.9%)出现腹痛、发热(n = 156;59.5%)和呕吐(n = 123;46.9%)。95 名 (36.3%) 患者的血培养呈阳性,79 名 (83.2%) 患者有单一微生物生长。30 天、90 天和住院死亡率分别为 3 (1.1%)、11 (4.2%) 和 15 (5.7%)。在多变量分析中,2 型糖尿病(OR = 12.531;95% CI 0.354–116.015;p= 0.026), 收缩压 #x3c;100 mm Hg (OR = 10.108; 95% CI 1.094–93.395; p = 0.041), 格拉斯哥昏迷评分 #x3c;15 (OR = 38.16; 95% CI 1.804–807.191; p = 0.019)和恶性肿瘤(OR = 14.135;95% CI 1.017–196.394;p = 0.049)预测住院死亡率。结论: TG13/18诊断标准比TG07诊断标准更敏感。2 型糖尿病、收缩压 #x3c;100 mm Hg、格拉斯哥昏迷评分 #x3c;15 和恶性病因可预测 AC 患者的住院死亡率。在 AC 患者的急性分层和治疗中可以考虑这些预测因素。
粘性医学
更新日期:2021-06-08
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