The impact of delayed biliary decompression and anti-microbial therapy in 260 patients with cholangitis-associated septic shock.
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Summary: Background: Cholangitis‐associated septic shock carries significant mortality. There is uncertainty regarding the most appropriate time to achieve biliary decompression. Aim: To determine whether the timing of biliary decompression and anti‐microbial therapy affect the survival in cholangitis patients with septic shock. Methods: Nested retrospective cohort study of all cholangitis‐associated septic shock patients (hypotension requiring vasopressors) from an international, multi‐centre database between 1996 and 2011. Results: Among 260 patients (mean age 69 years, 57% male), overall mortality was 37%. Compared to nonsurvivors (n = 96), survivors (n = 164) had lower mean admission Acute Physiology And Chronic Health Evaluation (APACHE) II (22 vs. 28, P < 0.001) and lower median serum lactate on admission (3.4 vs. 4.6 mmol/L, P < 0.001). Survivors were more likely to receive appropriate anti‐microbial therapy earlier (median 2.6 vs. 6.8 h from shock, P < 0.001). Survivors were also more likely to undergo successful biliary decompression earlier (median 8.8 vs. 22 h, P < 0.001). After adjusting for co‐variates, APACHE II (odds ratio, OR 1.21 per increment (1.11–1.32), time delay to appropriate anti‐microbial therapy [OR 1.15 per hour (1.07–1.25)] and delayed biliary decompression >12 h [OR 3.40 (1.12–10.31)] were all significantly associated with increased mortality (P < 0.04 for all; c‐statistic 0.896). Conclusions: Patients with septic shock secondary to acute cholangitis have significant mortality. Endoscopic biliary decompression >12 h after the onset of shock and delayed receipt of appropriate anti‐microbial therapy were both significantly associated with adverse hospital outcome. This might suggest that early initiation of anti‐microbial therapy and urgent biliary decompression (within 12 h) could potentially improve outcomes in this high‐risk patient population.
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Smaller studies suggest that source control within 6-12 hours is advantageous, and studies generally show reduced survival beyond that point.
“smaller studies suggest that source control within 6–12 h is advantageous [265–271]. Studies generally show reduced survival beyond that point.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [269]
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- Authors
- Karvellas, C. J., Abraldes, J. G., Zepeda‐Gomez, S., Moffat, D. C., Mirzanejad, Y., Vazquez‐Grande, G., Esfahani, E. K., Kumar, A., & the Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
- Affiliations
- University of Alberta (CA)
- Division of Gastroenterology and Hepatology University of Alberta Edmonton AB Canada
- University of Manitoba (CA)
- Surrey Memorial Hospital (CA)
- Section of Critical Care Medicine University of Manitoba Winnipeg MB Canada
- Corresponding author
- Karvellas, C. J.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2016-08-10
- Volume
- 44
- Issue
- 7
- Pages
- 755-766
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2479308360
- Semantic Scholar
- 1934553a10ca5b4ca89345fc5da34b17eeed0008
- Cited by
- 94
- References
- 37
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 14 · 2022: 10 · 2021: 26 · 2020: 11 · 2019: 13 · 2018: 2 · 2017: 5
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Cholangiocarcinoma and Gallbladder Cancer Studies
- Keywords
- cholangitis, septic shock, biliary decompression, endoscopic biliary drainage, antimicrobial therapy timing, mortality, APACHE II score, serum lactate, vasopressors, prognostic factors
- MeSH terms
- Acute Disease, Aged, Aged, 80 and over, Cholangitis, Female, Hospitalization, Humans, Male, Middle Aged, Retrospective Studies, Shock, Septic, Vasoconstrictor Agents, Odds Ratio, APACHE
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