Characteristics and clinical outcomes of acute cholangitis in older patients

Clinical Features and Prognosis of Acute Cholangitis in Octogenarians: A Prospective Comparative Study

Background: The data on acute cholangitis in the octogenarian population are very limited. This study aimed to examine the clinical characteristics of acute cholangitis and complications related to endoscopic retrograde cholangiopancreatography (ERCP) in octogenarians. Materials and Methods: This study was conducted prospectively between July 2022 and December 2023 and included 250 patients aged 65 years and older. Patients eligible for the study were divided into two groups: those aged ≥80 years (octogenarian) and those aged 65-79 years (non-octogenarian). These two groups were compared in terms of the clinical characteristics of cholangitis and ERCP-related complications. In addition, factors associated with in-hospital mortality were evaluated. Results: Out of 250 patients, 87 (34.8%) were octogenarians and 163 (65.2%) were non-octogenarians. The median age was 76 (69-82) years. Although the octogenarian group had higher rates of severe illness and intensive care unit admissions (p < 0.001 and p = 0.002, respectively), there were no significant differences in in-hospital mortality (p = 0.359) or ERCP-related complications (p = 0.417). Malignant etiology (odds ratio [OR]: 5.68, 95% confidence interval [CI]: 2.11-15.3), hypoalbuminemia (OR 0.18, 95% CI 0.07-0.45), and qSOFA score ≥ 2 (OR: 6.5, 95% CI: 1.7-24.5) were independent risk factors for in-hospital mortality. Conclusions: Being over 80 years old is not an indicator of poor outcomes, and ERCP can be safely performed on these patients. However, elderly patients with hypoalbuminemia, malignant etiology, or a qSOFA score of ≥2 should be closely monitored, regardless of their age.

The Comparison of Clinical Outcomes in Elderly (≥75 Years) and Non-Elderly (<75 Years) Patients with Acute Cholangitis Due to Choledocholithiasis

Background and Objectives: Acute cholangitis may be fatal, particularly in elderly patients. According to the Tokyo Guidelines 2018, those aged ≥75 years are classified as moderate (Grade II) severity. However, it has not been established whether age itself is the deciding factor of poor outcomes. We studied the impact of old age (≥75 years) on the mortality and morbidity of acute cholangitis due to choledocholithiasis. Materials and Methods: We retrospectively examined 260 patients with calculous acute cholangitis who had undergone biliary drainage. Patients were divided into two groups: elderly (≥75 years) and non-elderly (<75 years). We aimed to compare organ dysfunction, in-hospital mortality, intensive care unit (ICU) hospitalization, and the severity of acute cholangitis. Results: Of 260 patients, 134 (51.5%) were in the elderly group and 126 (48.5%) were in the non-elderly group. The mean age was 72.3 ± 14.4 years, and 152 (58.5%) were men. The elderly patients showed a higher incidence of shock (12.7% vs. 4.8%, p = 0.029), respiratory dysfunction (7.5% vs. 0%, p = 0.002), and renal dysfunction (8.2% vs. 0.8%, p = 0.006) than the non-elderly patients. The overall in-hospital mortality rate was 2.7%, with no significant differences between the elderly and the non-elderly (4.5% vs. 0.8%, p = 0.121). The incidence of severe acute cholangitis was significantly higher in the elderly group (26.9% vs. 9.5%, p < 0.001). However, there was no significant difference in the rates of ICU hospitalization (9.7% vs. 4%, p = 0.088) and lengths of hospital stay (LOS) (8.3 d vs. 7.1 d, p = 0.086). Conclusions: No difference was observed in the in-hospital mortality, ICU hospitalization, or LOS between the elderly (≥75 years) and the non-elderly (<75 years) with calculous acute cholangitis. However, severe acute cholangitis was significantly more frequent in elderly patients.