P2155 - Navigating Acute Cholangitis in Cirrhosis: A Retrospective Analysis of Outcomes and Procedural Choices

Ali Jaan, MD¹, Sangeetha Krishnamoorthy, ², Davidson Ugochukwu Nzenwata, ³, Alishba Shezal Ali, ⁴, Ahmed Zohdy Ibrahim, ⁵, Sylvia Osuagwu, ⁶, Qurat Ul Ain Muhammad, MBBS⁷, Adeena Maryyum, ⁸, Nosheen Hafeez, MD⁹
1Unity Hospital, Rochester, NY; 2Tianjin Medical University, Tianjin, Hubei, China; 3Obafemi Awolowo University, Ile-Ife, Osun, Nigeria; 4Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan; 5College of human medicine, Benha University, Benha, Al Qalyubiyah, Egypt; 6Caribbean Medical University School of Medicine, Curacao, Drenthe, Netherlands; 7Rawalpindi Medical University, Oklahoma City, OK; 8Ayub Medical College, Abbottabad, North-West Frontier, Pakistan; 9Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, AR

Introduction: Acute cholangitis (AC) is a life-threatening biliary infection resulting from bile stasis and bacterial overgrowth. Cirrhosis, on the other hand, is a progressive liver condition characterized by fibrosis and regenerative nodules, often leading to liver failure. The coexistence of AC and cirrhosis, with reduced capacity to mitigate inflammatory insults, likely results in worse prognosis. However, limited evidence exists regarding this relationship, and no guidelines address AC management in cirrhotic patients. This study aims to examine the relationship between cirrhosis and clinical outcomes in AC patients.

Methods: Our study involved a retrospective cohort analysis using the Nationwide Readmission Database (NRD) for the years 2016-2020. We included adult patients (aged ≥18 years) admitted with a principal diagnosis of AC and had either undergone endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous biliary drainage (PBD), utilizing the International Classification of Diseases, Tenth Revision, and Clinical Modifications (ICD-10-CM) codes. Analyses was performed using STATA, version 14.2.

Results: We included 48,466 AC patients of whom 1,990 (4.11%) patients had cirrhosis. Cirrhotic patients were younger and predominantly male. In-hospital mortality of AC was significantly higher in patients with cirrhosis when compared to those without cirrhosis (adjusted odds ratio (aOR) 3.37, P< 0.01) (Table 1). Furthermore, patients with cirrhosis had higher odds for septic shock, acute renal failure, and need for admission to the intensive care unit. Thus, patients with cirrhosis had higher odds of severe AC (aOR 1.81, P< 0.01). From a procedural viewpoint, cirrhotic patients had higher odds of undergoing PBD but lower odds of undergoing “early” ERCP (ERCP within 24 hours of admission). We also found that cirrhotic patients, when compared to their non-cirrhotic counterparts, were more likely to undergo PBD as opposed to early ERCP (aOR 1.44, P= 0.02). Finally, the rate of same-admission cholecystectomy (CCY) was also lower in patients with cirrhosis (aOR 0.44, P< 0.01).

Discussion: Cirrhosis profoundly affects the clinical trajectory and management of AC, resulting in poorer patient outcomes and a preference for PBD over early ERCP. These findings highlight the critical need for heightened clinical vigilance and tailored therapeutic approaches for this vulnerable population.


Figure: Table 1. Clinical outcomes and procedural performance in acute cholangitis hospitalizations, stratified by the presence of cirrhosis.

Disclosures:
Ali Jaan indicated no relevant financial relationships.
Sangeetha Krishnamoorthy indicated no relevant financial relationships.
Davidson Ugochukwu Nzenwata indicated no relevant financial relationships.
Alishba Shezal Ali indicated no relevant financial relationships.
Ahmed Zohdy Ibrahim indicated no relevant financial relationships.
Sylvia Osuagwu indicated no relevant financial relationships.
Qurat Ul Ain Muhammad indicated no relevant financial relationships.
Adeena Maryyum indicated no relevant financial relationships.
Nosheen Hafeez indicated no relevant financial relationships.

Ali Jaan, MD¹, Sangeetha Krishnamoorthy, ², Davidson Ugochukwu Nzenwata, ³, Alishba Shezal Ali, ⁴, Ahmed Zohdy Ibrahim, ⁵, Sylvia Osuagwu, ⁶, Qurat Ul Ain Muhammad, MBBS⁷, Adeena Maryyum, ⁸, Nosheen Hafeez, MD⁹. P2155 - Navigating Acute Cholangitis in Cirrhosis: A Retrospective Analysis of Outcomes and Procedural Choices, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.