Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality 
in patients over 80 years old

Ramkumar Mohan; Stefanie Wei Lynn Goh; GuanWei Tan; Sameer P. Junnarkar; CheongWei Huey; Vishal G. Shelat

doi:10.5114/ceh.2021.110996

eISSN: 2449-8238
ISSN: 2392-1099

Clinical and Experimental Hepatology

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abstract:

Original paper

Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality in patients over 80 years old

Ramkumar Mohan

^{1, 2}

,

Stefanie Wei Lynn Goh

²

,

GuanWei Tan

²

,

Sameer P. Junnarkar

³

,

CheongWei Huey

^{1, 3}

,

Vishal G. Shelat

^{1, 3, 4}

Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Ministry of Health Holdings, Singapore
Department of General Surgery, Tan Tock Seng Hospital, Singapore
Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore

Clin Exp HEPATOL 2021; 7, 4: 396-405

DOI: https://doi.org/10.5114/ceh.2021.110996

Online publish date: 2021/11/29

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AMA

Mohan R, Lynn Goh S, Tan G, P. Junnarkar S, Huey C, Shelat V. Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality 
in patients over 80 years old. Clinical and Experimental Hepatology. 2021;7(4):396-405. doi:10.5114/ceh.2021.110996.

APA

Mohan, R., Lynn Goh, S., Tan, G., P. Junnarkar, S., Huey, C.,  & Shelat, V. (2021). Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality 
in patients over 80 years old. Clinical and Experimental Hepatology, 7(4), 396-405. https://doi.org/10.5114/ceh.2021.110996

Chicago

Mohan, Ramkumar, Stefanie Wei Lynn Goh, GuanWei Tan, Sameer P. Junnarkar, CheongWei Huey,  and Vishal G. Shelat. 2021. "Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality 
in patients over 80 years old". Clinical and Experimental Hepatology 7 (4): 396-405. doi:10.5114/ceh.2021.110996.

Harvard

Mohan, R., Lynn Goh, S., Tan, G., P. Junnarkar, S., Huey, C.,  and Shelat, V. (2021). Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality 
in patients over 80 years old. Clinical and Experimental Hepatology, 7(4), pp.396-405. https://doi.org/10.5114/ceh.2021.110996

MLA

Mohan, Ramkumar et al. "Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality 
in patients over 80 years old." Clinical and Experimental Hepatology, vol. 7, no. 4, 2021, pp. 396-405. doi:10.5114/ceh.2021.110996.

Vancouver

Mohan R, Lynn Goh S, Tan G, P. Junnarkar S, Huey C, Shelat V. Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality 
in patients over 80 years old. Clinical and Experimental Hepatology. 2021;7(4):396-405. doi:10.5114/ceh.2021.110996.

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Introduction
This study aims to validate Tokyo guidelines (TG) TG07/TG13/TG18 criteria and identify predictors of in-hospital mortality in acute cholangitis (AC) patients over 80 years old.

Material and methods
This is a retrospective audit of AC patients from January 2009 to December 2016. Demographic, clinical, investigation, management, and mortality data were studied. Multinomial logistic regression analysis with stepwise variable selection identified predictors for in-hospital mortality.

Results
Three hundred and eighty-eight patients were treated for AC. One hundred and sixty-two (41.8%) patients were male. 230 (59.3%) patients had a history of biliary disease, 161 (41.5%) patients had type 2 diabetes mellitus (T2DM), and 98 (25.3%) patients had ischaemic heart disease (IHD). Abdominal pain (n = 226, 58.2%), pyrexia (n = 247, 63.7%), and vomiting (n = 159, 41.0%) were the common presenting symptoms. 191 (49.2%) patients had abdominal tenderness. Positive blood cultures were recorded in patients 158 (40.7%) patients. Escherichia coli was the most commonly identified organism (n = 117, 30.2%). 77 (19.8%), 188 (48.5%) and 123 (31.7%) patients were graded with mild, moderate, and severe AC, respectively. 30-day, 90-day, and in-hospital mortality were 9 (2.3%), 19 (4.9%) and 38 (9.8%), respectively. On multivariate analysis, systolic blood pressure ≤ 100 mmHg (OR = 3.817, 95% CI: 1.365-10.761, p = 0.011), hypoalbuminaemia < 28 gm/l (OR = 6.052, 95% CI: 2.635-13.904, p < 0.001), serum creatinine ≥ 176.8 (OR = 2.787, 95% CI: 1.146-6.778, p = 0.024) and international normalized ratio (INR) > 1.5 (OR = 3.247, 95% CI: 1.234-8.544, p = 0.017) were independent predictors of in-hospital mortality.

Conclusions
Hypotension, hypoalbuminaemia, elevated creatinine, and elevated INR predict in-hospital mortality in AC patients over 80 years old.

keywords:

Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in‑hospital mortality in patients over 80 years old

Ramkumar Mohan 1, 2 , Stefanie Wei Lynn Goh 2 , GuanWei Tan 2 , Sameer P. Junnarkar 3 , CheongWei Huey 1, 3 , Vishal G. Shelat 1, 3, 4

sepsis, cholangitis, biliary

Ramkumar Mohan

^{1, 2}

,

Stefanie Wei Lynn Goh

²

,

GuanWei Tan

²

,

Sameer P. Junnarkar

³

,

CheongWei Huey

^{1, 3}

,

Vishal G. Shelat

^{1, 3, 4}