Diagnostic value of acute phase reactants and scores used in the diagnosis of cholangitis in patients with purulent cholangitis

Abstract

Acute cholangitis is a clinical condition that occurs due to stasis and infection of the biliary system, which can recur if left untreated and may lead to life-threatening consequences. Early diagnosis, severity scoring based on the Tokyo Criteria at the time of diagnosis, and prompt initiation of treatment can help prevent mortality. This article aims to retrospectively review patients diagnosed with acute cholangitis by observing pus drainage during Endoscopic Retrograde Cholangiopancreatography (ERCP), determine the diagnostic values and prognostic effects of data obtained from complete blood counts and evaluate the diagnostic and severity criteria of acute cholangitis, including 331 patients who underwent the procedure and exhibited pus drainage, along with 300 healthy volunteers. We observed that the most common cause in the etiology of acute cholangitis was choledocholithiasis. There was a statistically significant difference between the healthy control group and the acute cholangitis group in terms of leukocyte count (WBC), red cell distribution width (RDW), platelet count (PLT), mean platelet volume/platelet count (MPV/PLT), neutrophil count/lymphocyte count ratio (NLR), and platelet count/lymphocyte count ratio (PLR) values. ROC analysis revealed that RDW, NLR, and PLR values had high sensitivity and specificity in distinguishing the acute cholangitis group from the healthy group. When we compared acute cholangitis severity groups, there was a statistically significant difference between the groups in terms of WBC, RDW, PLT, MPV/PLT, NLR, and PLR values. Due to the high sensitivity and specificity and easy accessibility of WBC, RDW, PLT, NLR, and PLR tests in diagnosing cholangitis, a closer and careful evaluation of these tests would be beneficial for early diagnosis and effective treatment of the disease. Additionally, this study confirms the high accuracy of the Tokyo Criteria in diagnosing acute cholangitis, highlighting the inadequacies of other clinical scoring systems.

Keywords

• Acute cholangitis
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Tokyo Criteria

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