Epidemiology & prognostic determinants of patients with bacteremic cholecystitis or cholangitis.

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Am J Gastroenterol. 2007 Mar;102(3):563-9.

Epidemiology and prognostic

determinants of patients with bacteremic cholecystitis or cholangitis.

Lee CC, Chang IJ, Lai YC, Chen SY, Chen SC.

Department of Emergency Medicine, Yun-Lin, Taiwan.

OBJECTIVES: To compare mortalities in patients with sepsis due to biliary tract

infections (BTIs) and due to infections from other

sources, and to identify independent predictors of mortality in these patients. METHODS: This study was part of a community-acquired

bloodstream infection (BSI) study that prospectively collected comprehensive

clinical, laboratory, and outcome data from 937 consecutive patients with

microbiologically documented BSI in the emergency department.

BTI was the confirmed source of 145 of the 937 BSIs. We determined the independent prognostic factors by

evaluating the correlation between 30-day mortality and various factors, for

example, comorbidity, clinical severity, related hepatobiliary complication, and decompressive

procedures. RESULTS: Patients with biliary sepsis had

a high percentage of Gram-negative (88.3%), polymicrobial

(26.9%), and anaerobic infections (6.9%). The 30-day overall

mortality was 11.7%. proportional hazard

regression analysis disclosed five significant independent predictors: acute

renal failure (hazard ratio, 95% confidence interval: 6.86, 6.02-25.5), septic

shock (5.83, 4.36-15.64), malignant obstruction (4.35, 1.89-12.96), direct type

hyperbilirubinemia (1.26, 1.1-1.42), and Charlson score > or =6 (1.57, 1.12-2.22). Compared with the remaining 792 patients in the source

population, patients with bacteremic BTI had

significantly better prognosis (log-rank test, P= 0.007). Adjusting

for age, comorbidity, and clinical severity, BTI was

still independently associated with better 30-day survival (0.25-0.76). CONCLUSIONS: Though the mortality rate in patients with bacteremic BTI is substantial, survival is better than in

those with bacteremia from other sources. The main prognostic factors identified in this study may

help clinicians recognize patients at high risk for early mortality so that

they can give prompt, appropriate treatment.

PMID: 17335448 [PubMed - indexed for MEDLINE]

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