Gigot et al identified clinical findings associated with mortality in patients with acute cholangitis. They used results of multivariate analysis to develop a scoring system to predict mortality. The authors are the University Paris Sud, France.
Parameters studied with logistic regression:
(1) acute renal failure
(2) associated liver abscesses
(3) high malignant biliary stricture
(4) associated liver cirrhosis
(5) radiologic cholangitis
(6) gender
(7) age of the patient
mortality =
= (0.401 * (points for acute renal failure)) + (0.312 * (points for liver abscesses)) + (0.242 * (points for high malignant biliary stricture)) + (0.173 * (points for liver cirrhosis)) + (0.1121 * (points for radiologic cholangitis)) + (0.045 * (points for gender)) + (0.0012 * (points for age)) + 0.046
where:
• points for first 5 parameters are: 0 if absent, 1 if present
• points for gender: 0 if male, 1 if female
• points for age: 0 if < 50 years, 1 if >= 50 years
NOTE: If the score is calculated as described, then values > 1.00 can be achieved if multiple risk factors are present; the maximum score is 1.33. I also tried putting the result in the equation 1 / (1 + EXP((-1) * (mortality))), but this did not give meaningful results.
A scoring system can be derived if each regression coefficient is multiplied by 20, then rounded to an integer.
Parameter |
Finding |
Points |
---|---|---|
acute renal failure |
present |
8 |
|
absent |
0 |
associated liver abscesses |
present |
6 |
|
absent |
0 |
high malignant biliary stricture |
present |
5 |
|
absent |
0 |
associated liver cirrhosis |
present |
4 |
|
absent |
0 |
radiologic cholangitis, S/P percutaneous transhepatic cholangiography (PTC) |
present |
2 |
|
absent |
0 |
gender |
female |
1 |
|
male |
0 |
age |
< 50 years |
0 |
|
>= 50 years |
1 |
after Table 6, page 437
score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 27
• The higher the score the greater the mortality rate, with scores >= 7 indicating a high risk population.
Score |
Mortality Rate |
---|---|
0 |
0% |
1 – 5 |
1.8% |
6 – 10 |
21% |
11 – 15 |
67% |
16 - 27 |
100% |
Purpose: To estimate the mortality for a patient with acute cholangitis using the scoring system of Gigot et al.
Specialty: Infectious Diseases, Gastroenterology
Objective: clinical diagnosis, including family history for genetics, criteria for diagnosis, severity, prognosis, stage
ICD-10: K83.0,