Unchanged mortality in patients with acute cholangitis despite an increase in malignant etiologies – a 25-year epidemiological study

Ming Tan*, Ove B. Schaffalitzky, Stig Borbjerg Laursen

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background and aims: Acute cholangitis (AC) is a rare but serious condition, with an incidence of 7.0 per 10,000 people and mortality rates up to 10%. The aim of this study was to describe changes in obstruction etiology, comorbidities, clinical factors, and mortality among AC patients during a 25-year period. Methods: Using a database of 11,563 consecutive ERCP-procedures performed from 1990–2015 at Odense University Hospital, we identified all AC cases during that period. Clinical and epidemiological data were collected from the database and the Danish Patient Registry. Association with 30-day mortality was investigated using multiple logistic regression analysis with adjustment for confounding factors. Results: In total, 775 consecutive and individual cases of AC were included. Among cases, 42% (n = 326) were of malignant etiology, with an increasing incidence over time (regression coefficient [95% CI]: 0.03 [0.01–0.04] per year; p =.01). Mean Charlson Comorbidity Index was 1.4, with an increase over time (regression coefficient [95% CI]: 0.04 [0.03–0.05] per year; p <.01). Malignant obstruction etiology was associated with 30-day mortality (OR [95% CI]: 1.11 [1.04–1.18]; p <.01). Overall 30-day mortality was 12% (n = 91). After adjustment for confounding factors, no significant changes in 30-day mortality were observed over time (OR [95% CI]: 1 [1–1.00]; p =.91 per year). Conclusion: Significant increases in the incidence of malignant obstruction etiology and severity of comorbidities among AC patients were observed during the study period. Despite those findings, 30-day mortality remained unchanged, potentially reflecting a general improvement in the management of AC.

OriginalsprogEngelsk
TidsskriftScandinavian Journal of Gastroenterology
Vol/bind54
Udgave nummer3
Sider (fra-til)335-341
ISSN0036-5521
DOI
StatusUdgivet - 4. apr. 2019

Fingeraftryk

Epidemiologic Studies
Comorbidity
Incidence
Databases
Endoscopic Retrograde Cholangiopancreatography
Registries
Logistic Models
Regression Analysis

Citer dette

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title = "Unchanged mortality in patients with acute cholangitis despite an increase in malignant etiologies – a 25-year epidemiological study",
abstract = "Background and aims: Acute cholangitis (AC) is a rare but serious condition, with an incidence of 7.0 per 10,000 people and mortality rates up to 10{\%}. The aim of this study was to describe changes in obstruction etiology, comorbidities, clinical factors, and mortality among AC patients during a 25-year period. Methods: Using a database of 11,563 consecutive ERCP-procedures performed from 1990–2015 at Odense University Hospital, we identified all AC cases during that period. Clinical and epidemiological data were collected from the database and the Danish Patient Registry. Association with 30-day mortality was investigated using multiple logistic regression analysis with adjustment for confounding factors. Results: In total, 775 consecutive and individual cases of AC were included. Among cases, 42{\%} (n = 326) were of malignant etiology, with an increasing incidence over time (regression coefficient [95{\%} CI]: 0.03 [0.01–0.04] per year; p =.01). Mean Charlson Comorbidity Index was 1.4, with an increase over time (regression coefficient [95{\%} CI]: 0.04 [0.03–0.05] per year; p <.01). Malignant obstruction etiology was associated with 30-day mortality (OR [95{\%} CI]: 1.11 [1.04–1.18]; p <.01). Overall 30-day mortality was 12{\%} (n = 91). After adjustment for confounding factors, no significant changes in 30-day mortality were observed over time (OR [95{\%} CI]: 1 [1–1.00]; p =.91 per year). Conclusion: Significant increases in the incidence of malignant obstruction etiology and severity of comorbidities among AC patients were observed during the study period. Despite those findings, 30-day mortality remained unchanged, potentially reflecting a general improvement in the management of AC.",
keywords = "Acute cholangitis, Epidemiology, Endoscopic Retrograde Cholangiopancreatography, ERCP, Etiology, Mortality, ERCP (MeSH term), mortality (MeSH term), Acute cholangitis (MeSH term), epidemiology (MeSH term), etiology (MeSH term)",
author = "Ming Tan and Schaffalitzky, {Ove B.} and Laursen, {Stig Borbjerg}",
year = "2019",
month = "4",
day = "4",
doi = "10.1080/00365521.2019.1585568",
language = "English",
volume = "54",
pages = "335--341",
journal = "Scandinavian Journal of Gastroenterology",
issn = "0036-5521",
publisher = "Taylor & Francis",
number = "3",

}

TY - JOUR

T1 - Unchanged mortality in patients with acute cholangitis despite an increase in malignant etiologies – a 25-year epidemiological study

AU - Tan, Ming

AU - Schaffalitzky, Ove B.

AU - Laursen, Stig Borbjerg

PY - 2019/4/4

Y1 - 2019/4/4

N2 - Background and aims: Acute cholangitis (AC) is a rare but serious condition, with an incidence of 7.0 per 10,000 people and mortality rates up to 10%. The aim of this study was to describe changes in obstruction etiology, comorbidities, clinical factors, and mortality among AC patients during a 25-year period. Methods: Using a database of 11,563 consecutive ERCP-procedures performed from 1990–2015 at Odense University Hospital, we identified all AC cases during that period. Clinical and epidemiological data were collected from the database and the Danish Patient Registry. Association with 30-day mortality was investigated using multiple logistic regression analysis with adjustment for confounding factors. Results: In total, 775 consecutive and individual cases of AC were included. Among cases, 42% (n = 326) were of malignant etiology, with an increasing incidence over time (regression coefficient [95% CI]: 0.03 [0.01–0.04] per year; p =.01). Mean Charlson Comorbidity Index was 1.4, with an increase over time (regression coefficient [95% CI]: 0.04 [0.03–0.05] per year; p <.01). Malignant obstruction etiology was associated with 30-day mortality (OR [95% CI]: 1.11 [1.04–1.18]; p <.01). Overall 30-day mortality was 12% (n = 91). After adjustment for confounding factors, no significant changes in 30-day mortality were observed over time (OR [95% CI]: 1 [1–1.00]; p =.91 per year). Conclusion: Significant increases in the incidence of malignant obstruction etiology and severity of comorbidities among AC patients were observed during the study period. Despite those findings, 30-day mortality remained unchanged, potentially reflecting a general improvement in the management of AC.

AB - Background and aims: Acute cholangitis (AC) is a rare but serious condition, with an incidence of 7.0 per 10,000 people and mortality rates up to 10%. The aim of this study was to describe changes in obstruction etiology, comorbidities, clinical factors, and mortality among AC patients during a 25-year period. Methods: Using a database of 11,563 consecutive ERCP-procedures performed from 1990–2015 at Odense University Hospital, we identified all AC cases during that period. Clinical and epidemiological data were collected from the database and the Danish Patient Registry. Association with 30-day mortality was investigated using multiple logistic regression analysis with adjustment for confounding factors. Results: In total, 775 consecutive and individual cases of AC were included. Among cases, 42% (n = 326) were of malignant etiology, with an increasing incidence over time (regression coefficient [95% CI]: 0.03 [0.01–0.04] per year; p =.01). Mean Charlson Comorbidity Index was 1.4, with an increase over time (regression coefficient [95% CI]: 0.04 [0.03–0.05] per year; p <.01). Malignant obstruction etiology was associated with 30-day mortality (OR [95% CI]: 1.11 [1.04–1.18]; p <.01). Overall 30-day mortality was 12% (n = 91). After adjustment for confounding factors, no significant changes in 30-day mortality were observed over time (OR [95% CI]: 1 [1–1.00]; p =.91 per year). Conclusion: Significant increases in the incidence of malignant obstruction etiology and severity of comorbidities among AC patients were observed during the study period. Despite those findings, 30-day mortality remained unchanged, potentially reflecting a general improvement in the management of AC.

KW - Acute cholangitis

KW - Epidemiology

KW - Endoscopic Retrograde Cholangiopancreatography

KW - ERCP

KW - Etiology

KW - Mortality

KW - ERCP (MeSH term)

KW - mortality (MeSH term)

KW - Acute cholangitis (MeSH term)

KW - epidemiology (MeSH term)

KW - etiology (MeSH term)

U2 - 10.1080/00365521.2019.1585568

DO - 10.1080/00365521.2019.1585568

M3 - Journal article

VL - 54

SP - 335

EP - 341

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

SN - 0036-5521

IS - 3

ER -