Predicting Clinical Outcomes in Acute Gallstone Cholangitis: are Tokyo 2018 Criteria the Answer?

Aims Endoscopic retrograde cholangiopancreatography (ERCP) has a pivotal role in the management of acute gallstone cholangitis (AGC), although timing is controversial. Tokyo 2018 Criteria (TC2018) allow severity categorisation, however stratifying the risk to determine ideal “Emergency Room (ER) to ERCP time” (ER-ERCPt) is an unmet need.

Aims: To assess the utility of TC2018 in predicting clinical outcomes (intrahospital mortality [IHM], admission to Intensive Care Unit [ICU] and length of stay [LOS]). To identify additional predictors and evaluate the impact of ER-ERCPt on clinical outcomes.

Methods Retrospective review of AGC admissions who met TC2018 for definite cholangitis and underwent ERCP, from January 2015 to December 2019. TC2018 were applied retrospectively.

Results 189 patients were included (average age:74.1±13.2 years;52.6 % male), 60 of which had mild, 84 moderate and 45 severe disease. Multivariate logistic regression analysis showed severe AGC (odds ratio(OR):18.3;p = 0.01), C-reactive protein(CPR)≥15 mg/dL (OR:7.1;p = 0.009) and lactate≥2 mmol/L (OR:10.5;p =  0.01) at admission as independent risk factors for ICU admission. Median LOS was 7 days with interquartile range 2-13. Severe AGC (p = 0.001), CPR≥15 mg/dL (p = 0.001) and lactate≥2 mmol/L (p = 0.01) were associated with significantly longer LOS. The IHM was 2,6 % (n=5; all severe AC). Lactate≥2 mmol/L was predictor of IHM (OR:15.7;p = 0.015). 53.3 % of severe patients had an ER-ERCPt<48 hours(h) (moderate:20.3 %;mild 21.3 %;p = 0.01). ER-ERCPt<48h was associated with lower LOS (p = 0.03), but not with significantly lower rate of ICU admission and IHM. Among severe patients, ER-ERCPt<24h was significantly associated with a greater reduction in organ failures (OF) in the first 48h of hospitalization (OR:0.24;p = 0.04).

Conclusions Severe AGC, lactate≥2 mmol/L and CPR≥15 mg/dL are independent prognostic factors of adverse outcomes (LOS and ICU admission). A shorter ER-ERCPt had positive impact in reducing LOS and number of OF. Inclusion of lactate and CPR may improve the current TC2018 with respect to risk stratification and subsequent management.

Citation: Sequeira C, Costa Santos I, Coelho M et al. OP117 PREDICTING CLINICAL OUTCOMES IN ACUTE GALLSTONE CHOLANGITIS: ARE TOKYO 2018 CRITERIA THE ANSWER?. Endoscopy 2021; 53: S49.

Publication History

Article published online:
19 March 2021