The value of albumin-related ratios in predicting disease severity and mortality in acute cholangitis

Year 2023, , 1244 - 1249, 29.10.2023

Bayram Yeşil , Bünyamin Sevim

https://doi.org/10.32322/jhsm.1350174

Abstract

Aims: Acute cholangitis is a potentially fatal bacterial illness that poses a significant risk to patients if not promptly addressed, despite the progress made in the field of diagnosis and treatment. Multiple laboratory and clinical data are employed in assessing the severity and fatality rates associated with acute cholangitis. This study aimed to assess the predictive utility of the ratio between elevated laboratory results and albumin levels in determining the severity of disease and mortality rates in patients with cholangitis.
Methods: The study comprised a cohort of 471 individuals diagnosed with acute cholangitis, alongside a control group of 150 individuals without acute cholangitis. The patients' information was acquired by conducting a retrospective search of the computerized database. The study collected data on the age, gender, routine laboratory parameters, concomitant disorders, etiology of cholangitis, and outcomes (discharge or death) of all patients. The patients were categorized into three grades, namely grade 1, grade 2, and grade 3, based on the severity of cholangitis, using the Tokyo 2018 standards as a reference.
Results: The study comprised a sample size of 621 people. Out of the whole sample size, 53.1% (330 individuals) were identified as male. The study observed a broad range of ages (23-98) with a median age of 67 years, which was found to be greater in the cholangitis group. Among the patients in the cholangitis group, a mortality rate of 6.8% (32 individuals) was observed. A notable disparity was seen in all laboratory parameters between the two groups. The cholangitis group had greater levels of albumin-related ratios, and there was a positive correlation observed between all ratios and the severity of the condition. In deceased individuals, there were greater rates observed for variables other than the γ-glutamyl transferase/albumin ratio (GAR). The results of both univariate and multivariate regression analyses demonstrated a significant correlation between the ratios of direct bilirubin to albumin (DBAR), international normalized ratio to albumin (IAR), neutrophil to albumin (NAR), and mortality. Additionally, the study revealed that the mortality and severity of cholangitis could be predicted by all the albumin-related ratios examined, particularly the INR/albumin ratio (IAR), as indicated by the ROC analysis.
Conclusion: It is posited that the utilization of albumin-related ratios, obtainable through routine laboratory testing, may serve as an effective means to assess the severity of acute cholangitis and predict mortality rates associated with the condition. Immediate biliary drainage is recommended for patients with elevated ratios.

Keywords

Acute cholangitis, albumin-related ratios, severity, mortality

Supporting Institution

None

Project Number

None

Thanks

None

References

• Kochar R, Banerjee S. Infections of the biliary tract. Gastrointest Endosc Clin N Am. 2013;23(2):199-218.
• Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):17-30.
• An Z, Braseth AL, Sahar N. Acute cholangitis: causes, diagnosis, and management. Gastroenterol Clin North Am. 2021;50(2):403-414.
• Sokal A, Sauvanet A, Fantin B, de Lastours V. Acute cholangitis: diagnosis and management. J Visc Surg. 2019;156(6):515-525.
• Lee JG. Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol. 2009;6(9):533-541.
• Chen M, Wang L, Wang Y, et al. Risk factor analysis of post-ERCP cholangitis: a single-center experience. Hepatobiliary Pancreat Dis Int. 2018;17(1):55-58.
• Hanau LH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am. 2000;14(3):521-546.
• Mosler P. Diagnosis and management of acute cholangitis. Curr Gastroenterol Rep. 2011;13(2):166-172.
• Sheinenzon A, Shehadeh M, Michelis R, Shaoul E, Ronen O. Serum albumin levels and inflammation. Int J Biol Macromol. 2021;184:857-862.
• 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. BMC Gastroenterol. 2016;16:15.
• Touzani S, El Bouazzaoui A, Bouyarmane F, et al. Factors associated with mortality in severe acute cholangitis in a moroccan intensive care unit: a retrospective analysis of 140 cases. Gastroenterol Res Pract. 2021;2021:4583493.
• Yıldız BD, Özden S, Saylam B, Martlı F, Tez M. Simplified scoring system for prediction of mortality in acute suppurative cholangitis. Kaohsiung J Med Sci. 2018;34(7):415-419.
• Umefune G, Kogure H, Hamada T, et al. Procalcitonin is a useful biomarker to predict severe acute cholangitis: a single-center prospective study. J Gastroenterol. 2017;52(6):734-745.
• Tagashira Y, Sakamoto N, Isogai T, et al. Impact of inadequate initial antimicrobial therapy on mortality in patients with bacteraemic cholangitis: a retrospective cohort study. Clin Microbiol Infect. 2017;23(10):740-747.
• Chen YH, Wang L, Feng SY, Cai WM, Chen XF, Huang ZM. The relationship between C-reactive protein/albumin ratio and disease activity in patients with inflammatory bowel disease. Gastroenterol Res Pract. 2020;2020:3467419.
• Behera MK, Mishra D, Sahu MK, et al. C-reactive protein/albumin and ferritin as predictive markers for severity and mortality in patients with acute pancreatitis. Prz Gastroenterol. 2023;18(2):168-174.
• Şahiner ES, Surel A, İnan O, Yılmaz Çakmak N, Altıparmak E, Ateş İ. The role of MPV/albumin ratio in determining disease severity in acute cholangitis in the emergency medicine. J Health Sci Med. 2022; 5(5): 1378-1384.
• Kang HS, Chung SP, You JS et al. Usefulness of BUN/albumin ratio in prediction of 28-day mortality in patients with acute cholangitis. J Korean Soc Emerg Med. 2015; 26(6): 491-499.
• Choi JS, Chung KS, Lee EH, et al. The role of bilirubin to albumin ratio as a predictor for mortality in critically ill patients without existing liver or biliary tract disease. Acute Crit Care. 2020;35(1):24-30.
• Çekmen B, Bildik B, Atiş ŞE, Güven H. The role of neutrophil-albumin ratio in the diagnosis of acute appendicitis and its efficacy in predicting perforation. Nötrofil/albümin oranının akut apandisit tanısındaki yeri ve perforasyonu öngörmedeki etkinliği. Ulus Travma Acil Cerrahi Derg. 2022;29(1):52-58.