oa A Comprehensive Approach To The Prediction Of Acute Calcular Cholangitis - The Qatar Experience

Introduction: The aim of the present study is to identify clinical, laboratory and radiological factors that can predict which patients may develop cholangitis. Methods: This is a retrospective case-control study based on patients admitted to Hamad Hospital from June'06 to November'10 with a diagnosis of AC secondary to CBD stones. The control group included patients with obstructive lithiasic jaundice not complicated by cholangitis. Both groups were compared and analysed with respect to demographics, previous medical/surgical history, laboratory investigations and surgical/endoscopic procedures. Results: The study comprised of 112 patients of 24 different nationalities. 53 patients presented with AC and 59 were admitted for management of obstructive jaundice. Although Asians had a greater prevalence of cholangitis (57.4%) compared to Middle Easterners (35.7%) and Africans (33.3%), this was not statistically significant (P=0.066). Laboratory tests significantly correlated to AC were leukocytosis (P<0.001), elevated Bilirubin (P=0.005), prolonged prothrombin time (P=0.001), elevated INR (P=0.001), elevated serum Creatinine (P=0.001) and BUN (P=0.001). In univariate analysis the logistic regression model showed that dark urine, fever, elevated WBC and BUN were strongly associated with cholangitis. Conclusions: Typical clinical signs of acute cholangitis, history of chronic liver disease, together with certain biochemical criteria are strongly associated with occurrence of acute lithiasic cholangitis. A larger prospective study may probably confirm these findings and help create a reproducible and simple predictive scoring system.