Acute cholangitis - predictive factors for emergency ERCP

Background: Acute cholangitis varies in severity from a mild form to severe cases which require urgent biliary decompression. Aim: This study was undertaken in order to develop a prognostic scoring sys tem that can be used to predict which patients are likely to require emerge ncy endoscopic retrograde cholangiopancreatogram (ERCP) upon admission. Methods: This is a prospective study of 142 consecutive patients with acute cholangitis. Emergency ERCP was performed in patients who did not respond to medical therapy. Results: Thirty-one patients (21.8%) required emergency ERCP. A maximum hea rt rate of more than 100/min, albumin of less than 30 g/L, bilirubin of mor e than 50 mu mol/L and prothrombin time of more than 14 s on admission were associated with failure of medical treatment and the need for emergency ER CP (P=0.001, <0.001, 0.006 and 0.004, respectively). By using these four fa ctors in a scoring system, 50.7% of those with a score of one or more requi red emergency ERCP compared with 1.5% of those with none of the four risk f actors (P<0.001). This scoring system has a sensitivity of 96.8% and a spec ificity of 59.6%. Conclusions: As patients with severe acute cholangitis show a higher mortal ity, we recommend that emergency ERCP be performed in patients with one or more of the four prognostic factors.