Lymphocyte count and NLR as predictive value for the severity of acute cholangitis.

OBJECTIVE: Acute cholangitis is a serious infectious condition in which systemic complications occur and can lead to mortality. In this study, we tried to elucidate the relationship between lymphocyte count and neutrophil-lymphocyte ratio (NLR) with disease severity in patients with acute cholangitis. PATIENTS AND METHODS: In this retrospective analysis, 633 patients who met the definitive diagnosis criteria for acute cholangitis were enrolled as the study group. In the same period, 155 patients without acute cholangitis who had normal inflammatory markers and underwent endoscopic retrograde cholangiopancreatography (ERCP) were included in the study as the control group. The lymphocyte count, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) of the acute cholangitis group, the control group, and the acute cholangitis group were compared according to the severity of cholangitis. RESULTS: There was a statistically significant correlation between the severity of cholangitis and the degree of lymphocytopenia (p<0.05). It was observed that as the disease severity increased, the proportion of patients with normal lymphocytopenia degree decreased, and abnormal findings increased. It was seen that the NLR and PLR results of the patients increased as the severity of cholangitis increased. CONCLUSIONS: As a result, one can conclude that the increase in the severity of cholangitis caused an increase in NLR and PLR and a decrease in lymphocytes. Although the increase in NLR and lymphocytopenia results were considered statistically significant, the increase in PLR was not at an acceptable level.

Endoscopic treatment of biliary complications after duct-to-duct biliary anastomosis in pediatric liver transplantation.

BACKGROUND: Studies reporting outcomes of endoscopic treatment methods in children who underwent liver transplantation (LT) is very limited. We present our outcomes, as a high-volume transplant center where endoscopic methods are preferred as the first choice in the treatment of biliary complications in children. METHODS: Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) as the first treatment approach for biliary complications after LT between 2005 and 2017 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical intervention. RESULTS: ERCP was performed in 49 patients who had a duct-to-duct anastomosis (38 living donor liver transplantation (LDLT), 11 deceased donor liver transplantation (DDLT)). The most common biliary complication was stricture. Our endoscopic success rate was 66.7% (18/27) and 75% (6/8) in LDLT and DDLT patients with stricture (p > 0.05), respectively. While our endoscopic success rate was 75% (3/4) in patients with leak alone after LDLT, it was 25% (1/4) in patients with leak and stricture in this group. The endoscopic success rate was 50% in two patients who had leak alone after DDLT. CONCLUSIONS: ERCP should be considered as a preferential treatment option for the management of biliary complications in pediatric liver transplant patients with duct-to-duct anastomosis, as in adults.

Relationship between nucleotide-binding oligomerization domain-containing protein 2 variants and severity of acute pancreatitis.

BACKGROUND AND AIM: Intestinal barrier dysfunction has been implicated in the development of infectious complications of acute pancreatitis. Nucleotide-Binding Oligomerization DomainContaining Protein 2 (NOD2) plays an important role in the proper functioning of intestinal defense mechanisms. Here, we investigated the frequency of NOD2 variants in patients with mild and severe acute pancreatitis. MATERIALS AND METHODS: Groups 1, 2 and 3 comprised healthy participants and patients with mild and severe pancreatitis, respectively. Four NOD2 variants and serum interleukin-6 (IL-6), Tumor Necrosis Factor-a (TNF-a) and lipopolysaccharide-binding protein (LBP) levels were analyzed. RESULTS: Three patients (3/32, 9.4%) in the severe pancreatitis group were positive for the p.R702W variant. This variant was negative in other groups. One, three and three patients in the healthy (1/27, 3.7%), mild (3/36, 8.3%) and severe pancreatitis (3/32, 9.4%) groups tested positive for the 1007fs variant, respectively. No significant differences in the frequencies of NOD2 variants were evident among the groups. Serum IL-6, TNF-a and LBP levels were markedly higher in the severe pancreatitis than the healthy and mild pancreatitis groups (all p<0.001). We observed no significant correlation between cytokine levels and NOD2 variants. CONCLUSION: Our results support an association between the presence of the p.R702W variant and severe pancreatitis.