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

Yıl 2024, Cilt: 41 Sayı: 3, 491 - 495, 30.09.2024

Merve Önder Köse , Özkul Yılmaz Çolak

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Boey JH, Way LW. Acute cholangitis. Annals of Surgery. 1980;191(3):264.
• Wada K, Takada T, Kawarada Y, Nımura Y, Mıura F, Yoshıda M, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. Journal of hepato-biliary-pancreatic surgery. 2007;14(1):52-8.
• Zımmer V, Lammert F. Acute Bacterial Cholangitis. Viszeralmedizin. 2015;31(3):166-72.
• Lee JG. Diagnosis and management of acute cholangitis. Nature Reviews Gastroenterology & Hepatology. 2009;6(9):533.
• Mosler P. Diagnosis and management of acute cholangitis. Current gastroenterology reports. 2011;13(2):166-72.
• Ahmed M. Acute cholangitis-an update. World journal of gastrointestinal pathophysiology. 2018;9(1):1.
• Orfanu Ae, Popescu C, Leuștean A, Negru Ar, Tılışcan C, Aramă V, et al. The Importance of Haemogram Parameters in the Diagnosis and Prognosis of Septic Patients. J Crit Care Med (Targu Mures). 2017;3(3):105-10.
• Ham SY, Yoon HJ, Nam SB, Yun BH, Eum D, Shın CS. Prognostic value of neutrophil/lymphocyte ratio and mean platelet volume/platelet ratio for 1-year mortality in critically ill patients. Sci Rep. 2020;10(1):21513.
• Hanau LH, Steıgbıgel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am. 2000;14(3):521-46.
• Sokal A, Sauvanet A, Fantın B, De Lastours V. Acute cholangitis: Diagnosis and management. J Visc Surg. 2019;156(6):515-25.
• Lan Cheong Wah D, Chrıstophı C, Muralıdharan V. Acute cholangitis: current concepts. ANZ J Surg. 2017;87(7-8):554-9.
• Mayumı T, Okamoto K, Takada T, Strasberg SM, Solomkın JS, Schlossberg D, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):96-100.
• Jıang J, Wang X, Cheng T, Han M, Wu X, Wan H, et al. Dynamic Monitoring of sTREM-1 and Other Biomarkers in Acute Cholangitis. Mediators Inflamm. 2020;2020:8203813.
• Karabulut B, Arcagok BC. New Diagnostic Possibilities for Early Onset Neonatal Sepsis: Red Cell Distribution Width to Platelet Ratio. Fetal Pediatr Pathol. 2020;39(4):297-306.
• Dogan P, Guney Varal I. Red cell distribution width as a predictor of late-onset Gram-negative sepsis. Pediatr Int. 2020;62(3):341-6.
• Qın YS, Lı QY, Yang FC, Zheng SS. Risk factors and incidence of acute pyogenic cholangitis. Hepatobiliary Pancreat Dis Int. 2012;11(6):650-4.
• Baughman RP, Lower EE, Flessa HC, Tollerud DJ. Thrombocytopenia in the intensive care unit. Chest. 1993;104(4):1243-7.
• Sharma B, Sharma M, Majumder M, Steıer W, Sangal A, Kalawar M. Thrombocytopenia in septic shock patients--a prospective observational study of incidence, risk factors and correlation with clinical outcome. Anaesth Intensive Care. 2007;35(6):874-80.
• Golwala ZM, Shah H, Gupta N, Sreenıvas V, Pulıyel JM. Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study. Afr Health Sci. 2016;16(2):356-62.
• Tamelytė E, Vaıčekauskıenė G, Dagys A, Lapınskas T, Jankauskaıtė L. Early Blood Biomarkers to Improve Sepsis/Bacteremia Diagnostics in Pediatric Emergency Settings. Medicina (Kaunas). 2019;55(4):99
• Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med. 2020;38(3):641-7.
• Can E, Hamılcıkan Ş, Can C. The Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio for Detecting Early-onset Neonatal Sepsis. J Pediatr Hematol Oncol. 2018;40(4):e229-e32.
• Augène E, Lareyre F, Chıkande J, Guıdı L, Ballaıth A, Bossert JN, et al. Platelet to lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia. PLoS One. 2019;14(7):e0219763.
• Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy. 2017;118(9):513-6.
• Kım YJ, Kang J, Ryoo SM, Ahn S, Huh JW, Kım WY. Platelet-lymphocyte Ratio After Granulocyte Colony Stimulating Factor Administration: an Early Prognostic Marker in Septic Shock Patients With Chemotherapy-Induced Febrile Neutropenia. Shock. 2019;52(2):160-5.
• Elbaset MA, Zahran MH, Hashem A, Ghobrıal FK, Elrefaıe E, Badawy M, et al. Could platelet to leucocytic count ratio (PLR) predict sepsis and clinical outcomes in patients with emphysematous pyelonephritis? J Infect Chemother. 2019;25(10):791-6.
• Çolakoğlu Ş M, Genç Moralar D, Çekmecelıoğlu BT, Hergünsel GO. Relationship of mortality with neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume in patients undergoing acute abdominal surgery. Ulus Travma Acil Cerrahi Derg. 2020;26(5):735-41.