中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 8
Aug.  2022
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(8): 1847-1853

A multivariate analysis of acute severe cholangitis and the establishment and evaluation of a risk prediction scoring model

DOI: 10.3969/j.issn.1001-5256.2022.08.024
  • 1.

    Department of Hepatobiliary Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730000, China

  • 2.

    Medical College of Northwest Minzu University, Lanzhou 730000, China

Research funding:

Applied Basic Research Prcject of Logistics Support Department of the Military Commission (20BJZ23)

More Information
  • Corresponding author: QIN Jianwei, qinjianwei@163.com(ORCID: 0000-0001-7663-1894)
  • Received Date: 2021-12-05
  • Accepted Date: 2022-01-06
  • Published Date: 2022-08-20
    Abstract
  •   Objective  To investigate the independent risk factors for acute severe cholangitis and related protective factors, and to construct a risk prediction scoring model for acute severe cholangitis.  Methods  A retrospective analysis was performed for the clinical data of 381 patients with acute cholangitis who were admitted to Department of Hepatobiliary Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, from January 2016 to July 2021, among whom there were 273 patients with non-severe cholangitis and 108 patients with severe cholangitis. Univariate and multivariate logistic regression analyses were used to screen out the independent risk factors for acute severe cholangitis and related protective factors, and then a logistic regression model was established. The receiver operating characteristic (ROC) curve was used to evaluate the discriminatory ability of the model, the calibration curve was used to evaluate the prediction accuracy of the model, and decision curve analysis (DCA) was used to evaluate the clinical value of the model. Moreover, the enhanced Bootstrap method was used to perform internal validation of the model and evaluate the performance of the model in internal validation. The model was visualized by the construction of Web calculator, nomogram, and scoring system. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups.  Results  The univariate and multivariate logistic regression analyses showed that total bilirubin (TBil) (odds ratio [OR]=1.014, 95% confidence interval [CI]: 1.009-1.020, P < 0.001), percentage of neutrophils (OR=1.128, 95%CI: 1.088-1.175, P < 0.001), and age (OR=1.053, 95%CI: 1.027-1.082, P < 0.001) were independent risk factors, and albumin (Alb) (OR=0.871, 95%CI: 0.817-0.924, P < 0.001) was a protective factor. The above independent risk factors and protective factor were included in the logistic regression analysis for model fitting, and the predictive model obtained had an area under the ROC curve (AUC) of 0.925 (95%CI: 0.897-0.952), with a specificity of 0.817 and a sensitivity of 0.935 at the optimal cut-off value of 0.245. The calibration curve showed that the predicted probability of the model was approximately equal to the actual probability, with a Brier value of 0.098, and the decision curve analysis showed that the model had a higher net income within the threshold probability interval of 0.1-0.9. Internal validation showed an AUCinternal validation of 0.915 and a Brier valueinternal verification of 0.106.  Conclusion  TBil, percentage of neutrophils, and age are independent risk factors for acute severe cholangitis, while Alb is a protective factor. The established risk prediction scoring model has good discriminatory ability, calibration, and clinical value and can identify patients with acute severe cholangitis at an early stage, which provides a reference for subsequent diagnosis and treatment.

     

    • FullText(HTML)
  • loading
    • References(23)
  • [1]
    Biliary Surgery Group, Surgery Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of acute biliary tract infections(2021)[J]. Chin J Surg, 2021, 59(6): 422-429. DOI: 10.3760/cma.j.cn112139-20210421-00180.

    中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南(2021版)[J]. 中华外科杂志, 2021, 59(6): 422-429. DOI: 10.3760/cma.j.cn112139-20210421-00180.
    [2]
    KIRIYAMA S, KOZAKA K, TAKADA T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)[J]. J Hepatobiliary Pancreat Sci, 2018, 25(1): 17-30. DOI: 10.1002/jhbp.512.
    [3]
    YANG DX, ZHANG Y, WANG XF, et al. Application of ultrasound-guided real - time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage in treatment of acute obstructive cholangitis in primary hospitals[J]. J Clin Hepatol, 2020, 36(4): 847-849. DOI: 10.3969/j.issn.1001-5256.2020.04.027.

    杨东晓, 张勇, 王雪峰, 等. 超声实时引导下经皮经肝胆管或胆囊穿刺置管引流术治疗急性梗阻性胆管炎在基层医院的应用[J]. 临床肝胆病杂志, 2020, 36(4): 847-849. DOI: 10.3969/j.issn.1001-5256.2020.04.027.
    [4]
    ZHANG Z, ZHAO BM. Successful emergency treatment of esophageal and gastric varices bleeding complicated with acute obstructive suppurative cholangitis: A case report[J/CD]. Chin J Gastrointestinal Endosc (Electronic Edition), 2020, 7(4): 211-212. DOI: 10.3877/cma.j.issn.2095-7157.2020.04.009.

    张哲, 赵保民. 食管胃静脉曲张破裂出血合并急性梗阻性化脓性胆管炎急诊救治成功1例[J/CD]. 中华胃肠内镜电子杂志, 2020, 7(4): 211-212. DOI: 10.3877/cma.j.issn.2095-7157.2020.04.009.
    [5]
    LU W, SUN DX, GAO JH, et al. Overview of big data analysis of precision medicine and modeling key technologies[J]. Chin Hosp Manage, 2021, 41(5): 19-25. https://www.cnki.com.cn/Article/CJFDTOTAL-YYGL202105009.htm

    路薇, 孙东旭, 高景宏, 等. 面向精准医疗的大数据分析与建模关键技术综述[J]. 中国医院管理, 2021, 41(5): 19-25. https://www.cnki.com.cn/Article/CJFDTOTAL-YYGL202105009.htm
    [6]
    KÖNIG IR, FUCHS O, HANSEN G, et al. What is precision medicine?[J]. Eur Respir J, 2017, 50(4): 1700391. DOI: 10.1183/13993003.00391-2017.
    [7]
    KIRIYAMA S, TAKADA T, HWANG TL, et al. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study[J]. J Hepatobiliary Pancreat Sci, 2017, 24(6): 329-337. DOI: 10.1002/jhbp.458.
    [8]
    TRAUNER M, FICKERT P, STAUBER RE. Inflammation-induced cholestasis[J]. J Gastroenterol Hepatol, 1999, 14(10): 946-959. DOI: 10.1046/j.1440-1746.1999.01982.x.
    [9]
    STRNAD P, TACKE F, KOCH A, et al. Liver - guardian, modifier and target of sepsis[J]. Nat Rev Gastroenterol Hepatol, 2017, 14(1): 55-66. DOI: 10.1038/nrgastro.2016.168.
    [10]
    Y1LD1Z BD, ÖZDEN S, SAYLAM B, et al. Simplified scoring system for prediction of mortality in acute suppurative cholangitis[J]. Kaohsiung J Med Sci, 2018, 34(7): 415-419. DOI: 10.1016/j.kjms.2017.12.016.
    [11]
    SCHWED AC, BOGGS MM, PHAM XD, et al. Association of admission laboratory values and the timing of endoscopic retrograde cholangiopancreatography with clinical outcomes in acute cholangitis[J]. JAMA Surg, 2016, 151(11): 1039-1045. DOI: 10.1001/jamasurg.2016.2329.
    [12]
    ZHANG F, LIU AL, GAO S, et al. Neutrophil dysfunction in sepsis[J]. Chin Med J (Engl), 2016, 129(22): 2741-2744. DOI: 10.4103/0366-6999.193447.
    [13]
    DU HW, QIN MF, WANG Q, et al. Analysis of mortality risk factors for acute cholangitis of severse type[J]. Shandong Med J, 2013, 53(7): 29-31. DOI: 10.3969/j.issn.1002-266X.2013.07.010.

    杜海伟, 秦鸣放, 王庆, 等. 重症急性胆管炎患者的死亡风险因素分析[J]. 山东医药, 2013, 53(7): 29-31. DOI: 10.3969/j.issn.1002-266X.2013.07.010.
    [14]
    GONG JP, WU CX, LIU CA, et al. Liver sinusoidal endothelial cell injury by neutrophils in rats with acute obstructive cholangitis[J]. World J Gastroenterol, 2002, 8(2): 342-345. DOI: 10.3748/wjg.v8.i2.342.
    [15]
    WANG RF, LYU Y, ZHANG XG. Advances in the diagnosis and treatment of severe acute cholangitis[J]. J Clin Hepatol, 2019, 35(12): 2622-2626. DOI: 10.3969/j.issn.1001-5256.2019.12.002.

    王荣峰, 吕毅, 张晓刚. 重症胆管炎的诊断与治疗[J]. 临床肝胆病杂志, 2019, 35(12): 2622-2626. DOI: 10.3969/j.issn.1001-5256.2019.12.002.
    [16]
    CHENG XY, NIU Q, WANG J, et al. Clinical value of emergency endoscopic retrograde cholangiopancreatography in the treatment of acute severe cholangitis secondary to common bile duct stones in the elderly[J]. Chin J Gerontol, 2022, 42(6): 1381-1384. DOI: 10.3969/j.issn.1005-9202.2022.06.031.

    程宪永, 牛琼, 王健, 等. 急诊ERCP治疗老年人胆总管结石继发急性重症胆管炎的临床价值[J]. 中国老年学杂志, 2022, 42(6): 1381-1384. DOI: 10.3969/j.issn.1005-9202.2022.06.031.
    [17]
    QIN YS, LI QY, YANG FC, et al. Risk factors and incidence of acute pyogenic cholangitis[J]. Hepatobiliary Pancreat Dis Int, 2012, 11(6): 650-654. DOI: 10.1016/s1499-3872(12)60240-9.
    [18]
    LIU Q, ZHOU Q, SONG M, et al. A nomogram for predicting the risk of sepsis in patients with acute cholangitis[J]. J Int Med Res, 2020, 48(1): 300060519866100. DOI: 10.1177/0300060519866100.
    [19]
    YIN M, SI L, QIN W, et al. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study[J]. J Intensive Care Med, 2018, 33(12): 687-694. DOI: 10.1177/0885066616685300.
    [20]
    KENDALL H, ABREU E, CHENG AL. Serum albumin trend is a predictor of mortality in ICU patients with sepsis[J]. Biol Res Nurs, 2019, 21(3): 237-244. DOI: 10.1177/1099800419827600.
    [21]
    ARNAU-BARRÉS I, GVERRI-FERNÁNDEZ R, LUQUE S, et al. Serum albumin is a strong predictor of sepsis outcome in elderly patients[J]. Eur J Clin Microbiol Infect Dis, 2019, 38(4): 743-746. DOI: 10.1007/s10096-019-03478-2.
    [22]
    SCHNEIDER J, HAPFELMEIER A, THÖRES S, et al. Mortality risk for acute cholangitis (MAC): a risk prediction model for in-hospital mortality in patients with acute cholangitis[J]. BMC Gastroenterol, 2016, 16: 15. DOI: 10.1186/s12876-016-0428-1.
    [23]
    GRAVITO-SOARES E, GRAVITO-SOARES M, GOMES D, et al. Clinical applicability of Tokyo guidelines 2018/2013 in diagnosis and severity evaluation of acute cholangitis and determination of a new severity model[J]. Scand J Gastroenterol, 2018, 53(3): 329-334. DOI: 10.1080/00365521.2018.1430255.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(6)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (492) PDF downloads(58) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return