Parameters identified as independent risk factors on multivariate analysis:
(1) age
(2) blood urea nitrogen (BUN)
(3) serum creatinine
(4) serum total bilirubin
(5) serum albumin
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
<= 60 years of age
|
0
|
|
|
> 60 years of age
|
1
|
|
BUN
|
<= 20 mg/dL
|
0
|
|
|
> 20 mg/dL
|
1
|
|
serum creatinine
|
<= 2.0 mg/dL
|
0
|
|
|
> 2.0 mg/dL
|
1
|
|
serum total bilirubin
|
<= 2.0 mg/dL
|
0
|
|
|
> 2.0 mg/dL
|
1
|
|
serum albumin
|
>= 2.5 g/dL
|
0
|
|
|
< 2.5 g/dL
|
1
|
total number of poor prognostic factors =
= SUM(points for all 5 parameters)
Interpretation:
• minimum number: 0
• maximum number: 5
• The higher the number of risk factors, the worse the prognosis.
Management:
(1) Antibiotic therapy and medical management is tried first.
(2) If the patient does not respond to medical management, then percutaneous drainage is attempted.
Indications for operative management:
(1) failure of percutaneous drainage and medical management
(2) complications associated with a common duct bile stone
(3) complications associated with abscess rupture
