Chandka Medical College, SMBBU Larkana, Sindh, Pakistan
Raja Taha Yaseen TY. Khan, MBBS, FCPS, ESEGH1, Ali Hyder, FCPS2, Salman Ahsam, FCPS, MRCP, ESEGH3, Vijesh Kumar, MBBS1, Sanjay Kirshan Kumar, FCPS4, Azhar Ali, MBBS1, Hina Ismail, FCPS5, Abbas Ali Tasneem, MBBS, FCPS1, Nasir Hassan Luck, FCPS1 1Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan; 2Chandka Medical College, SMBBU, Larkana, Sindh, Pakistan; 3Social Security Hospital, Faislabad, Faisalabad, Punjab, Pakistan; 4Ahalia Hospital, Abu Dhabi, Abu Dhabi, United Arab Emirates; 5University Hospital Limerick, Limerick, Limerick, Ireland Introduction: Acute cholangitis (AC) is a life-threatening condition characterized by biliary tract infection, often necessitating urgent intervention. Despite advances in diagnostics and therapy, mortality remains significant, especially in high-risk subgroups. Hypoalbuminemia, a marker of systemic inflammation and malnutrition, has emerged as a potential predictor of poor outcomes. This systematic review and meta-analysis aimed to evaluate the prognostic value of hypoalbuminemia for mortality in patients with acute cholangitis. Methods: A comprehensive search of multiple databases was performed to identify studies evaluating the association between hypoalbuminemia and mortality in patients with acute cholangitis. Eligible studies included adult patients with confirmed acute cholangitis, reported serum albumin levels either as continuous variables or with defined cut-off values, and provided mortality outcomes. Case reports, reviews, pediatric studies, and articles lacking relevant data were excluded. Statistical analysis was conducted using a random-effects model to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic, and publication bias was evaluated through funnel plots. Results: A total of nine studies comprising 3,210 patients with acute cholangitis were included in the meta-analysis. The pooled analysis revealed a significant association between hypoalbuminemia and increased mortality risk. In the subgroup where serum albumin was treated as a continuous variable, the pooled odds ratio (OR) for mortality was 2.85 (95% CI: 1.93–4.20), indicating that each unit decrease in albumin level was associated with nearly a threefold increase in mortality risk. In the subgroup using albumin cut-off values (most commonly ≤2.5 g/dL or ≤2.8 g/dL), the association was even stronger, with a pooled OR of 4.08 (95% CI: 2.58–6.45). Heterogeneity across studies was low to moderate (I² = 0% in the cut-off-based group and I² = 47% in the continuous variable group), suggesting consistency in the effect estimate, particularly when defined thresholds were used. Discussion: This meta-analysis highlights hypoalbuminemia as a strong and independent predictor of mortality in patients with acute cholangitis. Early recognition of low serum albumin levels should prompt aggressive clinical intervention and close monitoring.
Figure: Forest plot showing association of hypoalbuminemia with mortality in acute cholangitis at a cutoff of <2.8 g/dl
Figure: Forest plot showing association of hypoalbuminemia with mortality in acute cholangitis with each unit decrease in serum albumin levels (g/dl)
Disclosures: Raja Taha Yaseen Khan indicated no relevant financial relationships. Ali Hyder indicated no relevant financial relationships. Salman Ahsam indicated no relevant financial relationships. Vijesh Kumar indicated no relevant financial relationships. Sanjay Kirshan Kumar indicated no relevant financial relationships. Azhar Ali indicated no relevant financial relationships. Hina Ismail indicated no relevant financial relationships. Abbas Ali Tasneem indicated no relevant financial relationships. Nasir Hassan Luck indicated no relevant financial relationships.
Raja Taha Yaseen TY. Khan, MBBS, FCPS, ESEGH1, Ali Hyder, FCPS2, Salman Ahsam, FCPS, MRCP, ESEGH3, Vijesh Kumar, MBBS1, Sanjay Kirshan Kumar, FCPS4, Azhar Ali, MBBS1, Hina Ismail, FCPS5, Abbas Ali Tasneem, MBBS, FCPS1, Nasir Hassan Luck, FCPS1. P4280 - Hypoalbuminemia as a Predictor of Mortality in Patients With Acute Cholangitis: A Systemic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
