Proposed new simple scoring system to identify indications for urgent ERCP in acute cholangitis based on the Tokyo Guidelines.
J Hepatobiliary Pancreat Sci
; 19(6): 698-706, 2012 Nov.
Article
in En
| MEDLINE
| ID: mdl-22203454
ABSTRACT
BACKGROUND/PURPOSE:
The Tokyo Guidelines (TG) have enabled more accurate diagnosis of acute cholangitis (AC). This study was undertaken to develop a new prognostic scoring system to predict the need for urgent endoscopic retrograde cholangiopancreatography (ERCP) based on the clinical findings on admission.METHODS:
We prospectively reviewed 40 consecutive cases of AC and divided them into an urgent-ERCP group and an elective-ERCP group.RESULTS:
Univariate analysis identified four factors that predicted the need for urgent ERCP serum albumin level below 3.0 g/dl, blood urea nitrogen level above 20 mg/dl, platelet count below 120,000/µl, and the presence of systemic inflammatory response syndrome. These four predictors plus four predictors of organ dysfunction in the TG shock, consciousness disturbance, respiratory failure, and prothrombin time/international normalized ratio >1.5, were used to devise a scoring system in which 1 point was assigned for the first four predictors and 2 points were assigned for the latter four predictors (maximum score possible 12 points). The receiver-operator characteristic curve of the scores showed good test performance for predicting the need for urgent ERCP and for predicting a positive blood culture, and the areas under the concentration curves (AUCs) were 0.96 and 0.97, respectively. The optimal cut-off value for urgent ERCP was 2 points.CONCLUSIONS:
This new simple scoring system allows identification of high-risk AC patients soon after admission to hospital.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cholangitis
/
Cholangiopancreatography, Endoscopic Retrograde
/
Practice Guidelines as Topic
/
Emergencies
Type of study:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
Asia
Language:
En
Journal:
J Hepatobiliary Pancreat Sci
Year:
2012
Document type:
Article
Affiliation country:
Japan