Predictive Performance of Admission Hematological Parameters for Adverse Clinical Outcomes in Acute Cholangitis

Abstract

Objectives: This study aimed to evaluate the prognostic performance of hematological parameters, including red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR), in patients with acute cholangitis (AC). Materials and Methods: In this prospective study, 202 patients diagnosed with AC between December 2023 and August 2024 were included. The predictive performance of admission hematological parameters for clinical outcomes, including in-hospital mortality, bacteremia, need for inotropic support, prolonged hospital stay, intensive care unit (ICU) admission, and prolonged ICU stay, was assessed and compared. Results: Among the 202 patients, 16 (7.9%) died during hospitalization. Multivariate regression analysis identified RDW as an independent risk factor for in-hospital mortality (odds ratio [OR]: 2.25, 95% confidence interval [CI]: 1.48–3.42, p<0.001). For the composite outcome, both NLR (OR: 1.04, 95% CI: 1.01–1.07, p=0.009) and RDW (OR: 1.61, 95% CI: 1.26–2.10, p<0.001) were independent risk factors. Receiver operating characteristic (ROC) analysis showed that RDW had the highest predictive accuracy for both in-hospital mortality (AUC [95% CI]: 0.826 [0.711–0.941]) and the composite outcome (AUC [95% CI]: 0.761 [0.681–0.842]) At a cut-off value of 15.6, RDW yielded a sensitivity of 75% and specificity of 88.2% for predicting in-hospital mortality. Patients with RDW >15.6 had a 21.3-fold higher risk of in-hospital mortality compared to those with lower RDW values (OR: 21.3, 95% CI: 6.3-71.5). Conclusion: RDW demonstrated the strongest prognostic value among hematological parameters and may serve as a practical and reliable marker for early risk stratification in patients with AC.

Keywords

• acute cholangitis
• hematological parameters
• mortality

Akut Kolanjit Hastalarında Olumsuz Klinik Sonuçları Öngörmede Başvuru Hematolojik Parametrelerinin Tahmin Gücü

Abstract

Amaç: Bu çalışma, akut kolanjit (AC) hastalarında eritrosit dağılım genişliği (RDW) ve nötrofil-lenfosit oranı (NLR) dahil olmak üzere hematolojik parametrelerin prognostik performansını değerlendirmeyi amaçlamıştır. Gereç ve Yöntem: Bu prospektif çalışmaya, Aralık 2023 ile Ağustos 2024 tarihleri arasında AC tanısı almış 202 hasta dâhil edildi. Başvuru anındaki hematolojik parametrelerin, hastane içi mortalite, bakteriyemi, inotrop ihtiyacı, uzamış hastane yatışı, yoğun bakım (ICU) yatışı ve uzamış ICU yatışı gibi klinik sonuçları öngörme gücü değerlendirildi ve karşılaştırıldı. Bulgular: Çalışmaya dâhil edilen 202 hastanın 16’sı (%7.9) hayatını kaybetti. Çok değişkenli regresyon analizinde RDW, hastane içi mortalite için bağımsız bir risk faktörü olarak bulundu (odds ratio [OR]: 2.25, %95 güven aralığı [GA]: 1.48–3.42, p<0.001). Kompozit sonlanım açısından hem NLR (OR: 1.04, %95 GA: 1.01–1.07, p=0.009) hem de RDW (OR: 1.61, %95 GA: 1.26–2.10, p<0.001) bağımsız risk faktörleri olarak bulundu. ROC analizinde, hematolojik parametreler arasında hastane içi mortaliteyi ve kompozit sonlanımı en iyi öngören parametrenin RDW olduğu belirlendi (sırasıyla, AUC [%95 GA]: 0.826 [0.711–0.941] ve AUC [%95 GA]: 0.761 [0.681–0.842]). 15.6 kesme değeri için RDW’nin mortalite için duyarlılığı %75, özgüllüğü ise %88.2 olarak hesaplandı. RDW >15.6 olan hastaların, diğer hastalara kıyasla 21.3 kat daha fazla hastane içi mortalite riski taşıdığı saptandı (OR: 21.3, %95 GA: 6.3–71.5). Sonuç: RDW, hematolojik parametreler arasında en güçlü prognostik değeri göstermiştir ve AC hastalarında erken risk sınıflandırması için pratik ve güvenilir bir belirteç olarak hizmet edebilir.

Keywords

• akut kolanjit
• hematolojik parametreler
• mortalite

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