Charleen S Yeo1, Joseph Wong2, Lavisha Punjabi2, Winston Woon1, Jee Keem Low1, Terence Huey1, Junnarkar Sameer1, Vishal Shelat1. 1Tan Tock Seng Hospital, 2Lee Kong Chian School of Medicine
With improvements in healthcare access and technology, admissions of octogenarian population with acute cholangitis (AC) are increasing. Octogenarians are vulnerable to inferior outcomes. There is no study to evaluate factors predicting outcomes of AC in octogenarians. The aim of our study is identify factors predicting outcomes, and to evaluate the quick sequential organ failure assessment (qSOFA) score and Tokyo Guidelines 2013 (TG13) severity grading for octogenarian patients with AC.
A retrospective review of octogenarian patients admitted with AC from January 2010 to December 2016 was performed. Demographic profile, clinical presentation and discharge outcomes were studied. Systemic inflammatory response syndrome (SIRS), qSOFA and TG13 severity grading scores were calculated. Mortality is defined as death within 30 days of admission or in hospital mortality. Statistical analysis was performed using SPSS Version 21.
There were a total of 1875 patients admitted for AC, of which 284 (15%) were octogenarians. Majority (n=167, 59%) were female, with a mean age of 83 (range 80-86) years. Majority were secondary to gallstones (n=197, 69%), and 53 (19%) were due to malignancies. 140 (49%) and 8 (3%) patients fulfilled SIRS and qSOFA criteria of severity respectively. 142 (50%) and 93 (33%) of patients had a TG13 severity grading of moderate and severe respectively. Nine (3%) patients required inotropic support in the emergency department (ED) and 48 (17%) patients were admitted to critical care unit (CCU). 166 (58%) patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and 33 (12%) underwent percutaneous transhepatic biliary drainage (PTBD) for biliary decompression. 8 patients underwent index cholecystectomy. Length of stay was 11.5 (range 1-91) days and 30-day mortality of 11%.
Multivariate analysis performed showed that an abnormal Glasgow coma score (p=0.017) and malignancy (p<0.001) predicted 30-day mortality. The use of ED inotropic support predicted CCU admission (p=0034). A positive blood culture (p=0.005), presence of malignancy (p<0.001), use of ED inotropes (p=0.001), and index cholecystectomy (p=0.008) predicted a longer length of stay.
qSOFA (p<0.001) and TG13 severity grading (p=0.001) were predictive of 30-day mortality. SIRS criteria did not predict 30-day mortality.
Reduced consciousness and malignancy predicted 30-day mortality in octogenarian patients with AC. qSOFA and TG13 severity grading system is superior to SIRS criteria in predicting mortality of octogenerians with AC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87785
Program Number: P088
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster