Predicting early mortality following percutaneous stent insertion for malignant biliary obstruction: a multivariate risk factor analysis

Background Percutaneous stent placement is an accepted method of palliation in malignant biliary obstruction. Factors predicting early mortality after this procedure have not been identified. Methods We performed a retrospective study of 141 patients with malignant b iliary obstruction who underwent percutaneous stent placement for biliary d ecompression to identify the risk factors associated with early mortality ( less than or equal to 30 days). Results Of 14 clinicopathological and laboratory variables analysed blood u rea, albumin, haemoglobin and alkaline phosphatase were found to be signifi cant on univariate analysis. The age and gender of the patient along with c ancer type, level of obstruction, presence of pyrexia and bilirubin level h ad no influence on early mortality. Stepwise logistic regression identified the haemoglobin level and blood urea to be independently significant in pr edicting early mortality. Overall 30-day mortality was 20.5% (29/141). Pati ents with blood urea over 4.3 mmol/l and a haemoglobin less than 10.9 g/dl had a mortality rate of 52% (12/23) compared with 14% (17/118) in the remai nder. Using these two variables a regression equation has been derived whic h allows calculation of the probability of survival at 30 days after the pe rcutaneous procedure. Conclusions Laboratory variables in patients with malignant obstructive jau ndice can be used to predict mortality following percutaneous stent inserti on, (C) 2000 Lippincott Williams & Wilkins.