Lai et al identified risk factors associated with morbidity and mortality following emergency surgery for acute cholangitis. This can help identify patients who might benefit from nonoperative biliary drainage. The authors are from the University of Hong Kong.
Parameters associated with hospital mortality identified on multivariate analysis:
(1) pH
(2) platelet count in 10^9/L
(3) serum albumin in g/L
(4) concomitant medical problems (included myocardial infarction, renal failure, cirrhosis, malignancy, diabetes mellitus and acute bronchopneumonia)
(5) total serum bilirubin in µmol/L
discriminant function =
= (0.27 * ((platelet count in 10^9/L) / (10^9)) * 0.01) + (0.51 * (serum albumin in g/L) * 0.1) – (1.3 if concomitant medical problems present, else 0) – (0.72 * LOG10(serum bilirubin in µmol/L)) + (9.2 * (pH)) – 69 =
= (0.0027 * ((platelet count in 10^9/L) / (10^9))) + (0.0 * (serum albumin in g/L)) – (1.3 if concomitant medical problems present, else 0) – (0.72 * LOG10(serum bilirubin in µmol/L)) + (9.2 * (pH)) – 69
Patients who survived had a mean discriminant score of 0.43.
Patients who died had a mean value of (-1.7).
The precise breakpoint for separation is not stated but could be 0. The presence of a reduced pH (below 7.40) quickly affects the value of the discriminant function.
|
Parameter |
Finding |
Points |
|
pH |
>= 7.40 |
0 |
|
|
< 7.40 |
1 |
|
platelet count |
>= 150 * 10^9/L |
0 |
|
|
< 150 * 10^9/L |
1 |
|
serum albumin |
>= 30 g/L |
0 |
|
|
< 30 g/L |
1 |
|
concomitant medical problems |
absent |
0 |
|
|
present |
1 |
|
total serum bilirubin |
< 90 µmol/L |
0 |
|
|
>= 90 µmol/L |
1 |
|
Risk Factor |
Relative Risk |
|
pH < 7.40 |
3.5 |
|
platelet count < 150 * 10^9/L |
2.9 |
|
serum albumin < 30 g/L |
2.9 |
|
concomitant medical problem present |
4.5 |
|
total serum bilirubin >= 90µmol/L |
3.1 |
If one assumes that the risk factors are of equal weight:
number of risk factors =
= SUM(points for all 5 parameters)
|
Number of Risk Factors |
Morbidity |
Mortality |
|
0 |
0% |
0% |
|
1 |
32% |
3% |
|
2 |
48% |
7.1% |
|
3 |
82% |
36.4% |
|
4 |
100% |
83.3% |
|
5 |
100% |
100% |
Postoperative morbidities in the study group included: renal failure, respiratory failure, cardiac arrhythmias, wound infection, bronchopneumonia, heart failure, GI bleeding, myocardial ischemia, wound dehiscence, pleural effusions, renal abscess and DIC.
Specialty: Infectious Diseases, Gastroenterology
