Predictive factors for developing acute cholangitis due to choledocholithiasis

Predictive factors for developing acute cholangitis due to choledocholithiasis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictive factors for developing acute cholangitis due to choledocholithiasis Feifan Li, Meiqing Dai, Min Xu, Qidong Cui, Rongwei Shen, Xulin Zhou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4207354/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Acute cholangitis, an acute and severe disease in the clinic, is mostly caused by choledocholithiasis. This study aimed to identify the predictive factors for developing acute cholangitis due to choledocholithiasis. Methods A total of 558 patients with choledocholithiasis were enrolled. The patients were divided into a choledocholithiasis group (n = 399) and an acute cholangitis group (n = 159) according to whether they had acute cholangitis. The clinical data were analyzed, and logistic regression was used to predict acute cholangitis. Receiver operating characteristic (ROC) curves were generated to identify predictive factors for acute cholangitis. Results The acute cholangitis group had a greater prevalence of male sex, age ≥ 70 years, smoking history, hypertension, fever (> 38°C) and/or shaking chills, duodenal peripapillary diverticulum, and maximum diameter of choledocholithiasis (≥ 10 mm). Furthermore, the acute cholangitis group had higher WBC, CRP, T-Bil, ALT, AST, ALP, GGT, serum creatinine (Scr), prothrombin time (PT) and D-dimer (D-D) levels and lower albumin levels. Logistic regression analysis revealed that the maximum diameter of choledocholithiasis (≥ 10 mm), T-Bil, CRP, WBC, fever (> 38°C) and/or shaking chills, male sex, AST, and ALP were independent risk factors for developing acute cholangitis, with an area under the ROC curve (AUC) of 0.869 for CRP, 0.858 for T-Bil, 0.835 for WBC, 0.765 for AST and 0.743 for ALP. Conclusions Attention should be given to choledocholithiasis patients who have a maximum diameter of choledocholithiasis (≥ 10 mm), T-Bil > 34.25 µmol/L, CRP > 10.85 mg/L, WBC > 9.95×10 9 /L, fever (> 38℃) and/or shaking chills, male sex, ALP > 162.5 U/L and AST > 57.8 U/L. Interventions may be taken to prevent acute cholangitis. Acute cholangitis Choledocholithiasis ERCP Charcot’s triad Risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Acute cholangitis refers to acute inflammation of the intrahepatic and extrahepatic bile ducts. It is one of the most common severe diseases in gastroenterology, with an acute onset, rapid progression and high mortality. Without prompt treatment, the mortality rate can reach as high as 50%[ 1 , 2 ]. The common causes of acute cholangitis include choledocholithiasis, pancreatic cancer, porta hepatis tumor or metastasis, primary sclerosing cholangitis, Mirizzi syndrome, benign or malignant stricture of the bile/hepatic ducts and other factors that cause biliary obstruction[ 3 ]. As a common cause of acute cholangitis, gallstones are highly prevalent in the population, and acute cholangitis caused by gallstones is not rare. Relevant epidemiological studies show that 10%-15% of the world's population suffers from gallstones, and 1%-3% of the population suffers from acute cholecystitis or acute cholangitis every year[ 4 ]. Choledocholithiasis is a common disease in clinical practice, and its prognosis is generally favorable. However, when acute cholangitis develops, it can easily lead to severe complications such as infectious shock, sepsis, and multiple organ failure[ 5 ]. The prognosis in such patients is significantly worse. Therefore, the objective of this study was to focus on choledocholithiasis. By analyzing and comparing the clinical data of patients with choledocholithiasis and those with acute cholangitis due to choledocholithiasis, we aimed to identify the predictive factors for developing acute cholangitis due to choledocholithiasis. This knowledge makes early detection of patients who are prone to developing acute cholangitis possible. Methods Study population A total of 558 patients with choledocholithiasis admitted to the Affiliated Hospital of Jiangsu University between January 2021 and December 2022 were enrolled in the study. The patients were divided into two groups according to the presence of acute cholangitis: the choledocholithiasis group (n = 399) and the acute cholangitis group (n = 159). Inclusion criteria and exclusion criteria The inclusion criteria for the choledocholithiasis group were as follows: (1) imaging of choledocholithiasis or common bile duct dilatation. (2) Endoscopic retrograde cholangiopancreatography (ERCP) was performed during hospitalization. (3) Patients aged ≥ 18 years. Inclusion criteria for patients in the acute cholangitis group: Patients who met the diagnostic criteria for acute cholangitis were included in the choledocholithiasis group (Fig. 1 )[ 3 ]. The exclusion criteria were as follows: (1) biliary tract infection of other causes (such as gallbladder cancer, benign stricture of the common bile duct, congenital malformation of the biliary tract, secondary cholangitis after ERCP, duodenal papilla tumor, etc.). (2) ERCP failure due to various causes. (3) Patients whose clinical data were missing. (4) Complicated with respiratory tract, urinary tract, skin or soft tissue infections. (5) Complicated with hepatitis and liver abscess. (6) Traditional Chinese medicine may cause liver function damage. Data collection The general data collected included sex, age, previous history of cholecystectomy, previous ERCP history, smoking history, hypertension status, diabetes status, gallbladder stones, fever (> 38°C) and/or shaking chills, duodenal papillary diverticulum, and maximum diameter of choledocholithiasis (≥ 10 mm). Laboratory examination data , including white blood cell (WBC) counts, C-reactive protein (CRP) levels, total bilirubin (T-Bil) levels, alanine aminotransferase (ALT) levels, aspartate aminotransferase (AST) levels, alkaline phosphatase (ALP) levels, γ-glutamyl transferase γGTP (GGT) levels, albumin (Alb) levels, Scr levels, PT levels, and D-D levels, were collected. The following ERCP operation data were collected:odenal peripapillary diverticulum and maximum diameter of choledocholithiasis. Statistical analysis Statistical analysis was performed using SPSS 22.0. Normally distributed data are presented as the mean ± standard deviation (± s), and the independent samples t test was used for comparisons of the data between two groups. Nonnormally distributed data are presented as medians [interquartile ranges (IQRs)], and the Mann‒Whitney U test was used for comparisons of the data between two groups. Count data are presented as n (%) and were analyzed by the χ2 test. Logistic regression was used for analysis of the predictive factors for developing acute cholangitis. The diagnostic performance of the indicators was tested by the area under the receiver operating characteristic (ROC) curve. Statistical significance was indicated by P < 0.05. Results Comparison of counting dates between the two groups Compared with patients in the choledocholithiasis group, patients in the acute cholangitis group were significantly more likely to be male, ≥ 70 years old, have a smoking history, have hypertension, have fever (> 38°C) and/or shaking chills, have a duodenal peripapillary diverticulum, and have a maximum diameter of choledocholithiasis (≥ 10 mm) ( P 0.05) (Table 1 ). Table 1 Comparison of counting data between two groups Choledocholithiasis group(n = 399) Acute cholangitis group (n = 159) Statistical value P Male 191(47.9%) 97(61.0%) χ 2 = 7.856 0.005 Age ≥ 70 years old 69(17.3%) 54(34.0%) χ 2 = 18.384 <0.001 Previous history of cholecystectomy 101(25.3%) 50(31.4%) χ 2 = 2.167 0.141 Previous ERCP history 45(11.3%) 23(14.5%) χ 2 = 1.079 0.299 Smoking history 47(11.8%) 30(18.9%) χ 2 = 4.803 0.028 Hypertension 166(41.6%) 82(51.6%) χ 2 = 4.675 0.032 Diabetes 54(13.5%) 27(17.0%) χ 2 = 1.089 0.297 Gallbladder stones 218(54.6%) 74(46.5%) χ 2 = 2.987 0.084 Fever (> 38℃) and/or shaking chills 27(6.8%) 81(50.9%) χ 2 = 142.151 <0.001 Duodenal peripapillary diverticulum 50(12.5%) 31(19.5%) χ 2 = 4.445 0.035 Maximum diameter of choledocholithiasis (≥ 10 mm) 93(23.3%) 88(55.3%) χ 2 = 53.248 <0.001 Comparison of measurement data between the two groups Compared with the choledocholithiasis group, the acute cholangitis group had significantly greater WBC, CRP, T-Bil, ALT, AST, ALP, GGT, Scr, PT, and D-D levels ( P < 0.05) and significantly lower Alb levels (P < 0.05) (Table 2 ). Table 2 Comparison of measurement data between the two groups Choledocholithiasis group(n = 399) Acute cholangitis group (n = 159) Statistical value P WBC (10 9 /L) 6.20(4.90–7.80) 11.80(10.20–15.60) Z =-12.374 <0.001 CRP (mg/L) 2.00(0.50–10.90) 50.20(25.30-103.50) Z =-13.744 <0.001 T-Bil (µmol/L) 18.70(12.10–41.20) 79.40(55.60-106.20) Z =-13.224 <0.001 ALT (U/L) 57.70(20.60-219.20) 181.00(107.60–342.00) Z =-7.817 <0.001 AST (U/L) 36.80(19.50-129.50) 177.00(81.50–317.00) Z =-9.792 <0.001 ALP (U/L) 141.00(93.00-244.00) 253.00(174.00-370.00) Z =-8.975 <0.001 GGT (U/L) 182.00(45.00-451.00) 436.00(285.00-709.00) Z =-8.806 <0.001 Alb (g/L) 39.14 ± 5.57 37.20 ± 5.56 t = 3.717 <0.001 Scr (µmol/L) 63.50(53.50–75.10) 74.50(58.90–92.20) Z =-5.224 <0.001 PT (s) 11.40(10.90–12.00) 12.20(11.50–13.30) Z =-8.220 <0.001 D-D (mg/L) 0.60(0.32–1.14) 1.66(0.91–3.51) Z =-9.828 <0.001 WBC: white blood cell; CRP: C-reactive protein; T-Bil: total bilirubin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase; γGTP (GGT): γ-glutamyl transferase; Alb: albumin; Scr: serum creatinine; PT: prothrombin time; D-D: D-dimer Logistic regression analysis of the predictive factors of acute cholangitis Using choledocholithiasis as the dependent variable and sex, age ≥ 70 years, smoking history, hypertension history, fever (> 38°C) and/or shaking chills, duodenal papillary diverticulum, maximum diameter of choledocholithiasis (≥ 10 mm), WBC, CRP, T-Bil, ALT, AST, ALP, GGT, Alb, Scr, PT, and D-D as independent variables, binary logistic regression analysis was performed. The results showed that the maximum diameter of choledocholithiasis (≥ 10 mm) ( OR : 2.123, 95% CI : 1.091–4.131, P < 0.05), T-Bil ( OR : 1.015, 95% CI : 1.009–1.021, P < 0.001), CRP ( OR : 1.008, 95% CI : 1.000-1.015, P < 0.05), WBC ( OR : 1.338, 95% CI : 1.223–1.464, P 38°C) and/or shaking chills ( OR : 10.081, 95% CI : 4.664–21.790, P < 0.001), male sex ( OR : 2.207, 95% CI : 1.054–4.622, P < 0.05), AST ( OR : 1.003, 95% CI : 1.001–1.006, P < 0.01), and ALP ( OR : 1.002, 95% CI : 1.000-1.004, P < 0.05) were risk factors for acute cholangitis caused by choledocholithiasis. (Table 3 ) Table 3 Logistic regression analysis of the predictive factors of acute cholangitis β SE Waldχ2 OR 95% CI P Maximum diameter of choledocholithiasis (≥ 10 mm) 0.753 0.340 4.909 2.123 1.091–4.131 0.027 T-Bil 0.015 0.003 23.575 1.015 1.009–1.021 <0.001 CRP 0.008 0.004 3.989 1.008 1.000-1.015 0.046 WBC 0.291 0.046 40.474 1.338 1.223–1.464 38℃) and/or shaking chills 2.311 0.393 34.519 10.081 4.664–21.790 <0.001 Male 0.792 0.377 4.406 2.207 1.054–4.622 0.036 AST 0.003 0.001 7.300 1.003 1.001–1.006 0.007 ALP 0.002 0.001 4.856 1.002 1.000-1.004 0.028 T-Bil: total bilirubin; CRP: C-reactive protein; WBC: white blood cell; AST: aspartate aminotransferase; ALP: alkaline phosphatase; OR : odds ratio; CI : confidence interval Receiver operating characteristic (ROC) curves ROC curves revealed strong differences between the choledocholithiasis group and the acute cholangitis group, with an area under the ROC curve (AUC) of 0.869 (95% CI: 0.838-0.900) ( P < 0.001) for CRP (Fig. 2 ), 0.858 (95% CI: 0.827–0.889) ( P < 0.001) for T-Bil (Fig. 3 ), 0.835 (95% CI: 0.789–0.881) ( P < 0.001) for WBC (Fig. 4 ), 0.765 (95% CI: 0.726–0.804) ( P < 0.001) for AST (Fig. 5 ) and 0.743 (95% CI: 0.702–0.785) ( P < 0.001) for ALP (Fig. 6 ). An optimal cutoff of 9.95 for the WBC was used to predict the sensitivity and specificity of acute cholangitis at 78.6% and 90.8%, respectively. The optimal cutoff of 10.85 for CRP was used to predict the sensitivity and specificity of acute cholangitis at 93.7% and 74.9%, respectively. An optimal cutoff of 34.25 for T-Bil was used to predict the sensitivity and specificity of acute cholangitis at 91.8% and 71.7%, respectively. The optimal cutoff of 162.5 for ALP was used to predict the sensitivity and specificity of acute cholangitis at 82.4% and 60.2%, respectively. The optimal cutoff of 57.8 for the AST was used to predict the sensitivity and specificity of acute cholangitis at 86.2% and 60.9%, respectively. Discussion Risk factors for developing acute cholangitis When there is no biliary obstruction, simple biliary infection can be asymptomatic. Once acute cholangitis develops, it rapidly progresses to systemic inflammatory response syndrome (SIRS), sepsis and even death if it is not recognized and treated properly in the early stage[ 6 ]. Thus, it is critical to promptly identify patients who may easily progress to acute cholangitis. The previous diagnosis of acute cholangitis was based on Charcot’s triad. Although it has a specificity higher than 90%[ 7 ], its sensitivity is only 25%[ 8 – 10 ]. In this study, the diagnostic criteria for acute cholangitis referred to the 2018 Tokyo Guidelines[ 11 ], which exhibit good sensitivity (95.1%) but poor specificity (66.3%). In this study, the factors that may lead to choledocholithiasis in patients with acute cholangitis were first analyzed by single-factor analysis. Compared with patients in the choledocholithiasis group, patients in the acute cholangitis group were significantly more likely to be male, ≥ 70 years old, have a smoking history, have hypertension, have fever (> 38°C) and/or shaking chills, have a duodenal peripapillary diverticulum, and have a maximum diameter of choledocholithiasis (≥ 10 mm) (P < 0.05). Furthermore, the acute cholangitis group had significantly greater WBC, CRP, T-Bil, ALT, AST, ALP, GGT, Scr, PT, and D-D levels (P < 0.05) and significantly lower Alb levels (P < 0.05). However, single-factor analysis cannot control the influence of other factors on the observation indicators, which may enhance or weaken the effect of the observation indicators. Logistic regression analysis of the above indicators with P 38°C) and/or shaking chills, male sex, AST and ALP were independent risk factors for acute cholangitis ( P < 0.05). (1) Maximum diameter of choledocholithiasis (≥ 10 mm) The most common risk factor for acute cholangitis is choledocholithiasis[ 3 ]. The underlying mechanism may be that common bile duct stones block the bile duct, interfere with the enterohepatic circulation of bile, increase the pressure in the bile duct[ 10 ], and cause bile vein and bile lymph reflux[ 12 , 13 ], which subsequently leads to bacterial transcription in the bile duct. At present, there are few reports about the relationship between the diameter of choledocholithiasis and the risk of acute cholangitis. A previous study included a maximum diameter of choledocholithiasis (≥ 10 mm) as one of the risk factors for acute suppurative cholangitis[ 14 ]. In our study, we found that a maximum diameter of choledocholithiasis (≥ 10 mm) was an independent risk factor for acute cholangitis. (2) T-Bil When acute cholangitis occurs, the inflammatory reaction in the body tends to be severe. Some scholars[ 15 – 17 ] believe that inflammatory factors secreted by bile duct cells, such as TNF and IFN γ, can promote periodontal inflammation and inhibit the transport of chloride and bicarbonate ions in bile duct cells, thus hindering the flow of bile and resulting in hyperbilirubinemia. On the other hand, the central cause of acute cholangitis is biliary obstruction. Biliary obstruction and inflammation lead to an increase in bilirubin. The 2018 Tokyo Guidelines provided a grading system for severity, and T-Bil was included in this system[ 11 ]. T-Bil was also reported to be associated with in-hospital death[ 18 ]. Thus, we speculated that total bilirubin may be an independent risk factor for acute cholangitis. Our results confirmed this supposition. At the same time, the ROC curve was generated. The results indicated that acute cholangitis was most likely to occur when T-Bil was > 34.25 µmol/L. (3) WBC, CRP, fever (> 38°C) and/or shaking chills As indicators of inflammatory reactions, these indicators have high value in identifying choledocholithiasis with acute cholangitis. In particular, when the body temperature of patients with choledocholithiasis is more than 38°C and/or shaking chills occurs, acute cholangitis may occur. When CRP was > 10.85 mg/L, the sensitivity of diagnosing acute cholangitis was 93.7%, with a specificity of 74.9%. The area under the curve was 0.869. When the WBC count was > 9.95×10 9 /L, the sensitivity of diagnosing acute cholangitis was 78.6%, with a specificity of 90.8%. The area under the curve was 0.835. Therefore, it is essential to administer timely medical and bile duct drainage treatment. (4) Male sex The relationship between sex and acute cholangitis is not very clear. A large-scale study in the United States suggested that more than half of the hospitalized patients with acute cholangitis were over 60 years old, of which men accounted for the majority[ 2 ]. Another study also reported that men were more prone to developing acute cholangitis than women among patients with choledocholithiasis [ 19 ]. The results of this study also suggested that male sex was a risk factor for acute cholangitis, which may be related to androgen levels, anatomy of the biliary system, lifestyle and so on. (5) AST and ALP hepatocytes in the human body are linked by tight junctions, which are essential for maintaining the function of hepatic cells. By contributing as gatekeepers for paracellular diffusion between adherent hepatocytes and cholangiocytes, the blood-biliary barrier is shaped[ 20 ]. In patients with acute cholangitis, the pressure in the bile duct tends to be high. When the pressure in the bile duct rises to a certain level, the intercellular structure of the hepatocytes and the blood bile duct barrier may be destroyed, followed by patchy necrosis of hepatocytes, cholestasis and changes in liver function[ 21 ]. In this study, AST and ALP were found to be independent risk factors for developing acute cholangitis. When AST was > 57.8 U/L, the sensitivity of diagnosing acute cholangitis was 86.2%, with a specificity of 60.9%. The area under the curve was 0.765. When the ALP concentration was > 162.5 U/L, the sensitivity of diagnosing acute cholangitis was 82.4%, with a specificity of 60.2%. The area under the curve was 0.743. There are still some limitations in this study, such as the insufficient number of cases collected and the insufficient comprehensiveness of the collected data. It is not clear whether there are other possible risk factors for acute cholangitis. Conclusions Choledocholithiasis, a common disease in gastroenterology, can develop into acute cholangitis and may lead to more serious consequences, such as septic shock, sepsis, multiple organ failure and increased medical burden. Our results suggest that the maximum diameter of choledocholithiasis (≥ 10 mm), T-Bil, CRP, WBC, fever (> 38°C) and/or shaking chills, male sex, AST and ALP are independent risk factors for developing acute cholangitis. Attention should be given to choledocholithiasis patients who have a maximum diameter of choledocholithiasis (≥ 10 mm), T-Bil > 34.25 µmol/L, CRP > 10.85 mg/L, WBC > 9.95×10 9 /L, fever (> 38℃) and/or shaking chills, male sex, ALP > 162.5 U/L and AST > 57.8 U/L. To avoid the possibility of developing acute cholangitis, interventions, which may include more active antibiotic treatment and early ERCP, may be implemented in a timely manner. This deserves further exploration. Abbreviations ROC receiver operating characteristic curve WBC white blood cell CRP C-reactive protein T-Bil total bilirubin ALT alanine aminotransferase AST aspartate aminotransferase ALP alkaline phosphatase γGTP (GGT) γ-glutamyl transferase Scr Serum creatinine PT prothrombin time D-D D-dimer Alb Albumin ERCP Endoscopic retrograde cholangiopancreatography IQR interquartile range SIRS systemic inflammatory response syndrome TNF tumor necrosis factor IFNγ Interferonγ OR odds ratio CI confidence interval Declarations Ethics approval and consent to participate This study was conducted according to established ethical guidelines, and written informed consent was obtained from the patients or their family members. This study was approved by the Ethics Committee of the Affiliated Hospital of Jiangsu University. The approval number was KY2024K0303. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no potential conflicts of interest. Funding This study was supported by the National Natural Science Foundation of China (Grant No. 82072754). Authors' contributions Zhihua Wang had the idea for the article; Feifan Li performed the literature search and drafted the manuscript; Meiqing Dai participated in the data analysis; Min Xu made important revisions to the manuscript; and Qidong Cui, Rongwei Shen and Xulin Zhou participated in the data collection. All authors have read and approved the final manuscript. Acknowledgments We sincerely thank the patients who participated in this study. References Sulzer JK, Ocuin LM: Cholangitis: Causes, Diagnosis, and Management . The Surgical clinics of North America 2019, 99 (2):175-184. Babajide OI, Ogbon EO, Agbalajobi O, Ikeokwu A, Adelodun A, Obomanu ET: Clinical characteristics, predictors, and rates of hospitalized acute cholangitis patients in the United States . Annals of gastroenterology 2022, 35 (6):640-647. An Z, Braseth AL, Sahar N: Acute Cholangitis: Causes, Diagnosis, and Management . Gastroenterology clinics of North America 2021, 50 (2):403-414. Lammert F, Gurusamy K, Ko CW, Miquel JF, Méndez-Sánchez N, Portincasa P, van Erpecum KJ, van Laarhoven CJ, Wang DQ: Gallstones . Nature reviews Disease primers 2016, 2 :16024. Sun G, Han L, Yang Y, Linghu E, Li W, Cai F, Kong J, Wang X, Meng J, Du H et al : Comparison of two editions of Tokyo guidelines for the management of acute cholangitis . Journal of hepato-biliary-pancreatic sciences 2014, 21 (2):113-119. Lan Cheong Wah D, Christophi C, Muralidharan V: Acute cholangitis: current concepts . ANZ journal of surgery 2017, 87 (7-8):554-559. Everett BT, Naud S, Zubarik RS: Risk Factors for the Development of Stent-Associated Cholangitis Following Endoscopic Biliary Stent Placement . Digestive diseases and sciences 2019, 64 (8):2300-2307. Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Yokoe M et al : New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines . Journal of hepato-biliary-pancreatic sciences 2012, 19 (5):548-556. Kiriyama S, Takada T, Hwang TL, Akazawa K, Miura F, Gomi H, Mori R, Endo I, Itoi T, Yokoe M et al : Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study . Journal of hepato-biliary-pancreatic sciences 2017, 24 (6):329-337. Sokal A, Sauvanet A, Fantin B, de Lastours V: Acute cholangitis: Diagnosis and management . Journal of visceral surgery 2019, 156 (6):515-525. Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, Hata J, Liau KH, Miura F, Horiguchi A et al : Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos) . Journal of hepato-biliary-pancreatic sciences 2018, 25 (1):17-30. Barbier L, Souche R, Slim K, Ah-Soune P: Long-term consequences of bile duct injury after cholecystectomy . Journal of visceral surgery 2014, 151 (4):269-279. Rerknimitr R, Fogel EL, Kalayci C, Esber E, Lehman GA, Sherman S: Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis . Gastrointestinal endoscopy 2002, 56 (6):885-889. Tsujino T, Sugita R, Yoshida H, Yagioka H, Kogure H, Sasaki T, Nakai Y, Sasahira N, Hirano K, Isayama H et al : Risk factors for acute suppurative cholangitis caused by bile duct stones . European journal of gastroenterology & hepatology 2007, 19 (7):585-588. Strnad P, Tacke F, Koch A, Trautwein C: Liver - guardian, modifier and target of sepsis . Nature reviews Gastroenterology & hepatology 2017, 14 (1):55-66. Strazzabosco M, Fabris L, Spirli C: Pathophysiology of cholangiopathies . Journal of clinical gastroenterology 2005, 39 (4 Suppl 2):S90-s102. Spirlì C, Nathanson MH, Fiorotto R, Duner E, Denson LA, Sanz JM, Di Virgilio F, Okolicsanyi L, Casagrande F, Strazzabosco M: Proinflammatory cytokines inhibit secretion in rat bile duct epithelium . Gastroenterology 2001, 121 (1):156-169. Lavillegrand JR, Mercier-Des-Rochettes E, Baron E, Pène F, Contou D, Favory R, Préau S, Galbois A, Molliere C, Miailhe AF et al : Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study . Critical care (London, England) 2021, 25 (1):49. Khoury T, Sbeit W: Diabetes mellitus is associated with a higher rate of acute cholangitis among patients with common bile duct stones: A retrospective study . Medicine 2022, 101 (4):e28687. Roehlen N, Roca Suarez AA, El Saghire H, Saviano A, Schuster C, Lupberger J, Baumert TF: Tight Junction Proteins and the Biology of Hepatobiliary Disease . International journal of molecular sciences 2020, 21 (3). Pötter-Lang S, Ba-Ssalamah A, Bastati N, Messner A, Kristic A, Ambros R, Herold A, Hodge JC, Trauner M: Modern imaging of cholangitis . The British journal of radiology 2021, 94 (1125):20210417. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4207354","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":288433120,"identity":"e9a1119e-25da-4415-9310-15d0600ba8da","order_by":0,"name":"Feifan Li","email":"","orcid":"","institution":"Affiliated Hospital of Jiangsu University","correspondingAuthor":false,"prefix":"","firstName":"Feifan","middleName":"","lastName":"Li","suffix":""},{"id":288433121,"identity":"e60439e1-5f4a-4f14-94c0-231a55aed0e5","order_by":1,"name":"Meiqing Dai","email":"","orcid":"","institution":"Affiliated Hospital of Jiangsu University","correspondingAuthor":false,"prefix":"","firstName":"Meiqing","middleName":"","lastName":"Dai","suffix":""},{"id":288433122,"identity":"001a829d-5564-4f21-8e1e-b1ea4d7312f4","order_by":2,"name":"Min Xu","email":"","orcid":"","institution":"Affiliated Hospital of Jiangsu University","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Xu","suffix":""},{"id":288433123,"identity":"af4af648-5bab-4188-a593-5b4c6034d018","order_by":3,"name":"Qidong Cui","email":"","orcid":"","institution":"Affiliated Hospital of Jiangsu University","correspondingAuthor":false,"prefix":"","firstName":"Qidong","middleName":"","lastName":"Cui","suffix":""},{"id":288433124,"identity":"7e916157-9aae-4e60-8bb2-18e81867f7d4","order_by":4,"name":"Rongwei Shen","email":"","orcid":"","institution":"Affiliated Hospital of Jiangsu University","correspondingAuthor":false,"prefix":"","firstName":"Rongwei","middleName":"","lastName":"Shen","suffix":""},{"id":288433125,"identity":"f718b505-4f57-4ae9-9af6-6b6720a54e55","order_by":5,"name":"Xulin Zhou","email":"","orcid":"","institution":"Affiliated Hospital of Jiangsu University","correspondingAuthor":false,"prefix":"","firstName":"Xulin","middleName":"","lastName":"Zhou","suffix":""},{"id":288433126,"identity":"595d524e-5577-493a-8588-0367c99d6353","order_by":6,"name":"Zhihua Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYBACNmbGhgMJBhJy/OzNBxgkQEIHCGjhY28++OBDgYWxZM+xBOK0yPEcSzac8aEiccMMHwOIECEtbBI5ZtI8BhLGBhI83yQs/jDI8d1IYPxcQIQWOXPp3m0Skm0MxpI3EpilZxBji+Wcs0AtDQyJG24ksDHzEKEFqDLnmYTEH4Z6wlrA3odoYZOQYGNIMCCoBRzIQIcBA9nYQrJNwnDmmYfN0vi0yDeDovJPHSgqH96W+GMjz3c8+eBnfFpQALMEODIZG4jVAFT7gXi1o2AUjIJRMIIAAMg0SQAPAlQ/AAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Hospital of Jiangsu University","correspondingAuthor":true,"prefix":"","firstName":"Zhihua","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-04-02 14:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4207354/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4207354/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54368500,"identity":"1e977a84-7f0a-4827-806e-8b3cbbb98439","added_by":"auto","created_at":"2024-04-09 12:55:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":346458,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTG13 diagnostic criteria for acute cholangitis.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations: \u003c/strong\u003eSTD: upper limit of normal value; ALP: alkaline phosphatase; γGTP (GGT): γ-glutamyl transferase; AST: aspartate aminotransferase; ALT: alanine aminotransferase\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4207354/v1/8dd4af450dfad2200b50236d.png"},{"id":54368497,"identity":"5e8a583c-49e9-49ae-a374-6b07e021f9f1","added_by":"auto","created_at":"2024-04-09 12:55:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94937,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve of CRP.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe area under the ROC curve for CRP was 0.869 (95% \u003cem\u003eCI\u003c/em\u003e: 0.838-0.900, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). The optimal cutoff of 10.85 for CRP was used to predict the sensitivity and specificity of acute cholangitis at 93.7% and 74.9%, respectively.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4207354/v1/9a90977ee5e3fd57a58d96db.png"},{"id":54368495,"identity":"ff8ad9fb-f1fb-44f8-960c-2e20e5c4e50f","added_by":"auto","created_at":"2024-04-09 12:55:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":94384,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve of T-Bil.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe area under the ROC curve for T-Bil was 0.858 (95% \u003cem\u003eCI\u003c/em\u003e: 0.827-0.889, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). An optimal cutoff of 34.25 for T-Bil was used to predict the sensitivity and specificity of acute cholangitis at 91.8% and 71.7%, respectively.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4207354/v1/44a6ce25d68f019e70488618.png"},{"id":54368540,"identity":"c0532515-89c3-49e4-9171-16394097d600","added_by":"auto","created_at":"2024-04-09 12:56:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":106926,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve of WBC.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe area under the ROC curve for WBC was 0.835 (95% \u003cem\u003eCI\u003c/em\u003e: 0.789-0.881, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). An optimal cutoff of 9.95 for the WBC was used to predict the sensitivity and specificity of acute cholangitis at 78.6% and 90.8%, respectively.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4207354/v1/ff1134c1c5e75480f38f4cc0.png"},{"id":54368498,"identity":"8cb93070-741c-4944-84c4-ab31f4f198b4","added_by":"auto","created_at":"2024-04-09 12:55:51","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":100634,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve of AST.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe area under the ROC curve for AST was 0.765 (95% \u003cem\u003eCI\u003c/em\u003e: 0.726-0.804), \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). The optimal cutoff of 57.8 for the AST was used to predict the sensitivity and specificity of acute cholangitis at 86.2% and 60.9%, respectively.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-4207354/v1/a5fdcdb0042b441c68f099ca.png"},{"id":54368547,"identity":"98e54748-2c24-490c-91e9-5ba10b5de199","added_by":"auto","created_at":"2024-04-09 12:56:01","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":104191,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve of ALP.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe area under the ROC curve for ALP was 0.743 (95% \u003cem\u003eCI\u003c/em\u003e: 0.702-0.785, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). The optimal cutoff of 162.5 for ALP was used to predict the sensitivity and specificity of acute cholangitis at 82.4% and 60.2%, respectively.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-4207354/v1/4f3f6df00e1eea89641a726b.png"},{"id":78989639,"identity":"3ecda17e-5f7e-4197-80f0-b5840427eaad","added_by":"auto","created_at":"2025-03-21 19:53:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2444412,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4207354/v1/db271084-5e29-403a-82b6-680d4ec4023c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictive factors for developing acute cholangitis due to choledocholithiasis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute cholangitis refers to acute inflammation of the intrahepatic and extrahepatic bile ducts. It is one of the most common severe diseases in gastroenterology, with an acute onset, rapid progression and high mortality. Without prompt treatment, the mortality rate can reach as high as 50%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The common causes of acute cholangitis include choledocholithiasis, pancreatic cancer, porta hepatis tumor or metastasis, primary sclerosing cholangitis, Mirizzi syndrome, benign or malignant stricture of the bile/hepatic ducts and other factors that cause biliary obstruction[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As a common cause of acute cholangitis, gallstones are highly prevalent in the population, and acute cholangitis caused by gallstones is not rare. Relevant epidemiological studies show that 10%-15% of the world's population suffers from gallstones, and 1%-3% of the population suffers from acute cholecystitis or acute cholangitis every year[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Choledocholithiasis is a common disease in clinical practice, and its prognosis is generally favorable. However, when acute cholangitis develops, it can easily lead to severe complications such as infectious shock, sepsis, and multiple organ failure[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The prognosis in such patients is significantly worse. Therefore, the objective of this study was to focus on choledocholithiasis. By analyzing and comparing the clinical data of patients with choledocholithiasis and those with acute cholangitis due to choledocholithiasis, we aimed to identify the predictive factors for developing acute cholangitis due to choledocholithiasis. This knowledge makes early detection of patients who are prone to developing acute cholangitis possible.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eA total of 558 patients with choledocholithiasis admitted to the Affiliated Hospital of Jiangsu University between January 2021 and December 2022 were enrolled in the study. The patients were divided into two groups according to the presence of acute cholangitis: the choledocholithiasis group (n\u0026thinsp;=\u0026thinsp;399) and the acute cholangitis group (n\u0026thinsp;=\u0026thinsp;159).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for the choledocholithiasis group were as follows: (1) imaging of choledocholithiasis or common bile duct dilatation. (2) Endoscopic retrograde cholangiopancreatography (ERCP) was performed during hospitalization. (3) Patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years. Inclusion criteria for patients in the acute cholangitis group: Patients who met the diagnostic criteria for acute cholangitis were included in the choledocholithiasis group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The exclusion criteria were as follows: (1) biliary tract infection of other causes (such as gallbladder cancer, benign stricture of the common bile duct, congenital malformation of the biliary tract, secondary cholangitis after ERCP, duodenal papilla tumor, etc.). (2) ERCP failure due to various causes. (3) Patients whose clinical data were missing. (4) Complicated with respiratory tract, urinary tract, skin or soft tissue infections. (5) Complicated with hepatitis and liver abscess. (6) Traditional Chinese medicine may cause liver function damage.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e \u003cb\u003eThe general data\u003c/b\u003e collected included sex, age, previous history of cholecystectomy, previous ERCP history, smoking history, hypertension status, diabetes status, gallbladder stones, fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills, duodenal papillary diverticulum, and maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm).\u003c/p\u003e \u003cp\u003e \u003cb\u003eLaboratory examination data\u003c/b\u003e, including white blood cell (WBC) counts, C-reactive protein (CRP) levels, total bilirubin (T-Bil) levels, alanine aminotransferase (ALT) levels, aspartate aminotransferase (AST) levels, alkaline phosphatase (ALP) levels, γ-glutamyl transferase γGTP (GGT) levels, albumin (Alb) levels, Scr levels, PT levels, and D-D levels, were collected.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe following ERCP operation data\u003c/b\u003e were collected:odenal peripapillary diverticulum and maximum diameter of choledocholithiasis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS 22.0. Normally distributed data are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026plusmn;\u0026thinsp;s), and the independent samples t test was used for comparisons of the data between two groups. Nonnormally distributed data are presented as medians [interquartile ranges (IQRs)], and the Mann‒Whitney U test was used for comparisons of the data between two groups. Count data are presented as n (%) and were analyzed by the χ2 test. Logistic regression was used for analysis of the predictive factors for developing acute cholangitis. The diagnostic performance of the indicators was tested by the area under the receiver operating characteristic (ROC) curve. Statistical significance was indicated by \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eComparison of counting dates between the two groups\u003c/h2\u003e \u003cp\u003eCompared with patients in the choledocholithiasis group, patients in the acute cholangitis group were significantly more likely to be male, \u0026ge;\u0026thinsp;70 years old, have a smoking history, have hypertension, have fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills, have a duodenal peripapillary diverticulum, and have a maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there was no significant difference between the two groups in terms of previous history of cholecystectomy, previous ERCP history, diabetes or gallbladder stones (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of counting data between two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholedocholithiasis group(n\u0026thinsp;=\u0026thinsp;399)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcute cholangitis group (n\u0026thinsp;=\u0026thinsp;159)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e191(47.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97(61.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;7.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;70 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69(17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54(34.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;18.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious history of cholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101(25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50(31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;2.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious ERCP history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45(11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;1.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47(11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30(18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;4.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166(41.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82(51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;4.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54(13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27(17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;1.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGallbladder stones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e218(54.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74(46.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;2.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever (\u0026gt;\u0026thinsp;38℃) and/or shaking chills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27(6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81(50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;142.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuodenal peripapillary diverticulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50(12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31(19.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;4.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93(23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88(55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e2\u0026thinsp;=\u0026thinsp;53.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eComparison of measurement data between the two groups\u003c/h2\u003e \u003cp\u003eCompared with the choledocholithiasis group, the acute cholangitis group had significantly greater WBC, CRP, T-Bil, ALT, AST, ALP, GGT, Scr, PT, and D-D levels (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and significantly lower Alb levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of measurement data between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholedocholithiasis group(n\u0026thinsp;=\u0026thinsp;399)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcute cholangitis group (n\u0026thinsp;=\u0026thinsp;159)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.20(4.90\u0026ndash;7.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.80(10.20\u0026ndash;15.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-12.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.00(0.50\u0026ndash;10.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.20(25.30-103.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-13.744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT-Bil (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.70(12.10\u0026ndash;41.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.40(55.60-106.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-13.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57.70(20.60-219.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181.00(107.60\u0026ndash;342.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-7.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.80(19.50-129.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177.00(81.50\u0026ndash;317.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-9.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALP (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141.00(93.00-244.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e253.00(174.00-370.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-8.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGGT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e182.00(45.00-451.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e436.00(285.00-709.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-8.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlb (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScr (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63.50(53.50\u0026ndash;75.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.50(58.90\u0026ndash;92.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-5.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT (s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.40(10.90\u0026ndash;12.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.20(11.50\u0026ndash;13.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-8.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-D (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.60(0.32\u0026ndash;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.66(0.91\u0026ndash;3.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=-9.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eWBC: white blood cell; CRP: C-reactive protein; T-Bil: total bilirubin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase; γGTP (GGT): γ-glutamyl transferase; Alb: albumin; Scr: serum creatinine; PT: prothrombin time; D-D: D-dimer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eLogistic regression analysis of the predictive factors of acute cholangitis\u003c/h2\u003e \u003cp\u003eUsing choledocholithiasis as the dependent variable and sex, age\u0026thinsp;\u0026ge;\u0026thinsp;70 years, smoking history, hypertension history, fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills, duodenal papillary diverticulum, maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm), WBC, CRP, T-Bil, ALT, AST, ALP, GGT, Alb, Scr, PT, and D-D as independent variables, binary logistic regression analysis was performed. The results showed that the maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm) (\u003cem\u003eOR\u003c/em\u003e: 2.123, 95% \u003cem\u003eCI\u003c/em\u003e: 1.091\u0026ndash;4.131, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), T-Bil (\u003cem\u003eOR\u003c/em\u003e: 1.015, 95% \u003cem\u003eCI\u003c/em\u003e: 1.009\u0026ndash;1.021, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), CRP (\u003cem\u003eOR\u003c/em\u003e: 1.008, 95% \u003cem\u003eCI\u003c/em\u003e: 1.000-1.015, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), WBC (\u003cem\u003eOR\u003c/em\u003e: 1.338, 95% \u003cem\u003eCI\u003c/em\u003e: 1.223\u0026ndash;1.464, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills (\u003cem\u003eOR\u003c/em\u003e: 10.081, 95% \u003cem\u003eCI\u003c/em\u003e: 4.664\u0026ndash;21.790, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), male sex (\u003cem\u003eOR\u003c/em\u003e: 2.207, 95% \u003cem\u003eCI\u003c/em\u003e: 1.054\u0026ndash;4.622, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), AST (\u003cem\u003eOR\u003c/em\u003e: 1.003, 95% \u003cem\u003eCI\u003c/em\u003e: 1.001\u0026ndash;1.006, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and ALP (\u003cem\u003eOR\u003c/em\u003e: 1.002, 95% \u003cem\u003eCI\u003c/em\u003e: 1.000-1.004, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were risk factors for acute cholangitis caused by choledocholithiasis. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis of the predictive factors of acute cholangitis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eWaldχ2\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.091\u0026ndash;4.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT-Bil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.009\u0026ndash;1.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000-1.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.223\u0026ndash;1.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever (\u0026gt;\u0026thinsp;38℃) and/or shaking chills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.664\u0026ndash;21.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.054\u0026ndash;4.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.001\u0026ndash;1.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000-1.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eT-Bil: total bilirubin; CRP: C-reactive protein; WBC: white blood cell; AST: aspartate aminotransferase; ALP: alkaline phosphatase; \u003cem\u003eOR\u003c/em\u003e: odds ratio; \u003cem\u003eCI\u003c/em\u003e: confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eReceiver operating characteristic (ROC) curves\u003c/h2\u003e \u003cp\u003eROC curves revealed strong differences between the choledocholithiasis group and the acute cholangitis group, with an area under the ROC curve (AUC) of 0.869 (95% CI: 0.838-0.900) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for CRP (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), 0.858 (95% CI: 0.827\u0026ndash;0.889) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for T-Bil (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), 0.835 (95% CI: 0.789\u0026ndash;0.881) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for WBC (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), 0.765 (95% CI: 0.726\u0026ndash;0.804) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for AST (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) and 0.743 (95% CI: 0.702\u0026ndash;0.785) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for ALP (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). An optimal cutoff of 9.95 for the WBC was used to predict the sensitivity and specificity of acute cholangitis at 78.6% and 90.8%, respectively. The optimal cutoff of 10.85 for CRP was used to predict the sensitivity and specificity of acute cholangitis at 93.7% and 74.9%, respectively. An optimal cutoff of 34.25 for T-Bil was used to predict the sensitivity and specificity of acute cholangitis at 91.8% and 71.7%, respectively. The optimal cutoff of 162.5 for ALP was used to predict the sensitivity and specificity of acute cholangitis at 82.4% and 60.2%, respectively. The optimal cutoff of 57.8 for the AST was used to predict the sensitivity and specificity of acute cholangitis at 86.2% and 60.9%, respectively.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for developing acute cholangitis\u003c/h2\u003e \u003cp\u003eWhen there is no biliary obstruction, simple biliary infection can be asymptomatic. Once acute cholangitis develops, it rapidly progresses to systemic inflammatory response syndrome (SIRS), sepsis and even death if it is not recognized and treated properly in the early stage[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Thus, it is critical to promptly identify patients who may easily progress to acute cholangitis. The previous diagnosis of acute cholangitis was based on Charcot\u0026rsquo;s triad. Although it has a specificity higher than 90%[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], its sensitivity is only 25%[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this study, the diagnostic criteria for acute cholangitis referred to the 2018 Tokyo Guidelines[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which exhibit good sensitivity (95.1%) but poor specificity (66.3%). In this study, the factors that may lead to choledocholithiasis in patients with acute cholangitis were first analyzed by single-factor analysis. Compared with patients in the choledocholithiasis group, patients in the acute cholangitis group were significantly more likely to be male, \u0026ge;\u0026thinsp;70 years old, have a smoking history, have hypertension, have fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills, have a duodenal peripapillary diverticulum, and have a maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, the acute cholangitis group had significantly greater WBC, CRP, T-Bil, ALT, AST, ALP, GGT, Scr, PT, and D-D levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and significantly lower Alb levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, single-factor analysis cannot control the influence of other factors on the observation indicators, which may enhance or weaken the effect of the observation indicators. Logistic regression analysis of the above indicators with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was performed. Logistic regression analysis revealed that the maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm), T-Bil, CRP, WBC, fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills, male sex, AST and ALP were independent risk factors for acute cholangitis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(1) Maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm)\u003c/strong\u003e \u003cp\u003eThe most common risk factor for acute cholangitis is choledocholithiasis[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The underlying mechanism may be that common bile duct stones block the bile duct, interfere with the enterohepatic circulation of bile, increase the pressure in the bile duct[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and cause bile vein and bile lymph reflux[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which subsequently leads to bacterial transcription in the bile duct. At present, there are few reports about the relationship between the diameter of choledocholithiasis and the risk of acute cholangitis. A previous study included a maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm) as one of the risk factors for acute suppurative cholangitis[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In our study, we found that a maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm) was an independent risk factor for acute cholangitis.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(2) T-Bil\u003c/strong\u003e \u003cp\u003eWhen acute cholangitis occurs, the inflammatory reaction in the body tends to be severe. Some scholars[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] believe that inflammatory factors secreted by bile duct cells, such as TNF and IFN γ, can promote periodontal inflammation and inhibit the transport of chloride and bicarbonate ions in bile duct cells, thus hindering the flow of bile and resulting in hyperbilirubinemia. On the other hand, the central cause of acute cholangitis is biliary obstruction. Biliary obstruction and inflammation lead to an increase in bilirubin. The 2018 Tokyo Guidelines provided a grading system for severity, and T-Bil was included in this system[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. T-Bil was also reported to be associated with in-hospital death[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Thus, we speculated that total bilirubin may be an independent risk factor for acute cholangitis. Our results confirmed this supposition. At the same time, the ROC curve was generated. The results indicated that acute cholangitis was most likely to occur when T-Bil was \u0026gt;\u0026thinsp;34.25 \u0026micro;mol/L.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(3) WBC, CRP, fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills\u003c/strong\u003e \u003cp\u003eAs indicators of inflammatory reactions, these indicators have high value in identifying choledocholithiasis with acute cholangitis. In particular, when the body temperature of patients with choledocholithiasis is more than 38\u0026deg;C and/or shaking chills occurs, acute cholangitis may occur. When CRP was \u0026gt;\u0026thinsp;10.85 mg/L, the sensitivity of diagnosing acute cholangitis was 93.7%, with a specificity of 74.9%. The area under the curve was 0.869. When the WBC count was \u0026gt;\u0026thinsp;9.95\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L, the sensitivity of diagnosing acute cholangitis was 78.6%, with a specificity of 90.8%. The area under the curve was 0.835. Therefore, it is essential to administer timely medical and bile duct drainage treatment.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(4) Male sex\u003c/strong\u003e \u003cp\u003eThe relationship between sex and acute cholangitis is not very clear. A large-scale study in the United States suggested that more than half of the hospitalized patients with acute cholangitis were over 60 years old, of which men accounted for the majority[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Another study also reported that men were more prone to developing acute cholangitis than women among patients with choledocholithiasis [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The results of this study also suggested that male sex was a risk factor for acute cholangitis, which may be related to androgen levels, anatomy of the biliary system, lifestyle and so on.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(5) AST and ALP\u003c/strong\u003e \u003cp\u003ehepatocytes in the human body are linked by tight junctions, which are essential for maintaining the function of hepatic cells. By contributing as gatekeepers for paracellular diffusion between adherent hepatocytes and cholangiocytes, the blood-biliary barrier is shaped[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In patients with acute cholangitis, the pressure in the bile duct tends to be high. When the pressure in the bile duct rises to a certain level, the intercellular structure of the hepatocytes and the blood bile duct barrier may be destroyed, followed by patchy necrosis of hepatocytes, cholestasis and changes in liver function[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this study, AST and ALP were found to be independent risk factors for developing acute cholangitis. When AST was \u0026gt;\u0026thinsp;57.8 U/L, the sensitivity of diagnosing acute cholangitis was 86.2%, with a specificity of 60.9%. The area under the curve was 0.765. When the ALP concentration was \u0026gt;\u0026thinsp;162.5 U/L, the sensitivity of diagnosing acute cholangitis was 82.4%, with a specificity of 60.2%. The area under the curve was 0.743.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThere are still some limitations in this study, such as the insufficient number of cases collected and the insufficient comprehensiveness of the collected data. It is not clear whether there are other possible risk factors for acute cholangitis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eCholedocholithiasis, a common disease in gastroenterology, can develop into acute cholangitis and may lead to more serious consequences, such as septic shock, sepsis, multiple organ failure and increased medical burden. Our results suggest that the maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm), T-Bil, CRP, WBC, fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills, male sex, AST and ALP are independent risk factors for developing acute cholangitis. Attention should be given to choledocholithiasis patients who have a maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm), T-Bil\u0026thinsp;\u0026gt;\u0026thinsp;34.25 \u0026micro;mol/L, CRP\u0026thinsp;\u0026gt;\u0026thinsp;10.85 mg/L, WBC\u0026thinsp;\u0026gt;\u0026thinsp;9.95\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L, fever (\u0026gt;\u0026thinsp;38℃) and/or shaking chills, male sex, ALP\u0026thinsp;\u0026gt;\u0026thinsp;162.5 U/L and AST\u0026thinsp;\u0026gt;\u0026thinsp;57.8 U/L. To avoid the possibility of developing acute cholangitis, interventions, which may include more active antibiotic treatment and early ERCP, may be implemented in a timely manner. This deserves further exploration.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ereceiver operating characteristic curve\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ewhite blood cell\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eC-reactive protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eT-Bil\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etotal bilirubin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eALT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ealanine aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003easpartate aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eALP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ealkaline phosphatase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eγGTP (GGT)\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eγ-glutamyl transferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eScr\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSerum creatinine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eprothrombin time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eD-D\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eD-dimer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAlb\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlbumin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eERCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndoscopic retrograde cholangiopancreatography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003einterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSIRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esystemic inflammatory response syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTNF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etumor necrosis factor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIFNγ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterferonγ\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eodds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cem\u003eCI\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to established ethical guidelines,\u0026nbsp;and written informed consent was obtained from the patients or their family members. This study was approved by\u0026nbsp;the\u0026nbsp;Ethics Committee of\u0026nbsp;the\u0026nbsp;Affiliated Hospital of Jiangsu University. The approval number was KY2024K0303.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from\u003c/p\u003e\n\u003cp\u003ethe corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the National Natural Science Foundation of China (Grant No. 82072754).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhihua Wang had the idea for the article; Feifan Li performed the literature search and drafted the manuscript; Meiqing Dai participated in the data analysis; Min Xu made important revisions to the manuscript; and Qidong Cui, Rongwei Shen and Xulin Zhou participated in the data collection. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the patients who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSulzer JK, Ocuin LM: \u003cstrong\u003eCholangitis: Causes, Diagnosis, and Management\u003c/strong\u003e. \u003cem\u003eThe Surgical clinics of North America \u003c/em\u003e2019, \u003cstrong\u003e99\u003c/strong\u003e(2):175-184.\u003c/li\u003e\n\u003cli\u003eBabajide OI, Ogbon EO, Agbalajobi O, Ikeokwu A, Adelodun A, Obomanu ET: \u003cstrong\u003eClinical characteristics, predictors, and rates of hospitalized acute cholangitis patients in the United States\u003c/strong\u003e. \u003cem\u003eAnnals of gastroenterology \u003c/em\u003e2022, \u003cstrong\u003e35\u003c/strong\u003e(6):640-647.\u003c/li\u003e\n\u003cli\u003eAn Z, Braseth AL, Sahar N: \u003cstrong\u003eAcute Cholangitis: Causes, Diagnosis, and Management\u003c/strong\u003e. \u003cem\u003eGastroenterology clinics of North America \u003c/em\u003e2021, \u003cstrong\u003e50\u003c/strong\u003e(2):403-414.\u003c/li\u003e\n\u003cli\u003eLammert F, Gurusamy K, Ko CW, Miquel JF, M\u0026eacute;ndez-S\u0026aacute;nchez N, Portincasa P, van Erpecum KJ, van Laarhoven CJ, Wang DQ: \u003cstrong\u003eGallstones\u003c/strong\u003e. \u003cem\u003eNature reviews Disease primers \u003c/em\u003e2016, \u003cstrong\u003e2\u003c/strong\u003e:16024.\u003c/li\u003e\n\u003cli\u003eSun G, Han L, Yang Y, Linghu E, Li W, Cai F, Kong J, Wang X, Meng J, Du H\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eComparison of two editions of Tokyo guidelines for the management of acute cholangitis\u003c/strong\u003e. \u003cem\u003eJournal of hepato-biliary-pancreatic sciences \u003c/em\u003e2014, \u003cstrong\u003e21\u003c/strong\u003e(2):113-119.\u003c/li\u003e\n\u003cli\u003eLan Cheong Wah D, Christophi C, Muralidharan V: \u003cstrong\u003eAcute cholangitis: current concepts\u003c/strong\u003e. \u003cem\u003eANZ journal of surgery \u003c/em\u003e2017, \u003cstrong\u003e87\u003c/strong\u003e(7-8):554-559.\u003c/li\u003e\n\u003cli\u003eEverett BT, Naud S, Zubarik RS: \u003cstrong\u003eRisk Factors for the Development of Stent-Associated Cholangitis Following Endoscopic Biliary Stent Placement\u003c/strong\u003e. \u003cem\u003eDigestive diseases and sciences \u003c/em\u003e2019, \u003cstrong\u003e64\u003c/strong\u003e(8):2300-2307.\u003c/li\u003e\n\u003cli\u003eKiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, B\u0026uuml;chler MW, Yokoe M\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eNew diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines\u003c/strong\u003e. \u003cem\u003eJournal of hepato-biliary-pancreatic sciences \u003c/em\u003e2012, \u003cstrong\u003e19\u003c/strong\u003e(5):548-556.\u003c/li\u003e\n\u003cli\u003eKiriyama S, Takada T, Hwang TL, Akazawa K, Miura F, Gomi H, Mori R, Endo I, Itoi T, Yokoe M\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eClinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study\u003c/strong\u003e. \u003cem\u003eJournal of hepato-biliary-pancreatic sciences \u003c/em\u003e2017, \u003cstrong\u003e24\u003c/strong\u003e(6):329-337.\u003c/li\u003e\n\u003cli\u003eSokal A, Sauvanet A, Fantin B, de Lastours V: \u003cstrong\u003eAcute cholangitis: Diagnosis and management\u003c/strong\u003e. \u003cem\u003eJournal of visceral surgery \u003c/em\u003e2019, \u003cstrong\u003e156\u003c/strong\u003e(6):515-525.\u003c/li\u003e\n\u003cli\u003eKiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, Hata J, Liau KH, Miura F, Horiguchi A\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eTokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)\u003c/strong\u003e. \u003cem\u003eJournal of hepato-biliary-pancreatic sciences \u003c/em\u003e2018, \u003cstrong\u003e25\u003c/strong\u003e(1):17-30.\u003c/li\u003e\n\u003cli\u003eBarbier L, Souche R, Slim K, Ah-Soune P: \u003cstrong\u003eLong-term consequences of bile duct injury after cholecystectomy\u003c/strong\u003e. \u003cem\u003eJournal of visceral surgery \u003c/em\u003e2014, \u003cstrong\u003e151\u003c/strong\u003e(4):269-279.\u003c/li\u003e\n\u003cli\u003eRerknimitr R, Fogel EL, Kalayci C, Esber E, Lehman GA, Sherman S: \u003cstrong\u003eMicrobiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis\u003c/strong\u003e. \u003cem\u003eGastrointestinal endoscopy \u003c/em\u003e2002, \u003cstrong\u003e56\u003c/strong\u003e(6):885-889.\u003c/li\u003e\n\u003cli\u003eTsujino T, Sugita R, Yoshida H, Yagioka H, Kogure H, Sasaki T, Nakai Y, Sasahira N, Hirano K, Isayama H\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eRisk factors for acute suppurative cholangitis caused by bile duct stones\u003c/strong\u003e. \u003cem\u003eEuropean journal of gastroenterology \u0026amp; hepatology \u003c/em\u003e2007, \u003cstrong\u003e19\u003c/strong\u003e(7):585-588.\u003c/li\u003e\n\u003cli\u003eStrnad P, Tacke F, Koch A, Trautwein C: \u003cstrong\u003eLiver - guardian, modifier and target of sepsis\u003c/strong\u003e. \u003cem\u003eNature reviews Gastroenterology \u0026amp; hepatology \u003c/em\u003e2017, \u003cstrong\u003e14\u003c/strong\u003e(1):55-66.\u003c/li\u003e\n\u003cli\u003eStrazzabosco M, Fabris L, Spirli C: \u003cstrong\u003ePathophysiology of cholangiopathies\u003c/strong\u003e. \u003cem\u003eJournal of clinical gastroenterology \u003c/em\u003e2005, \u003cstrong\u003e39\u003c/strong\u003e(4 Suppl 2):S90-s102.\u003c/li\u003e\n\u003cli\u003eSpirl\u0026igrave; C, Nathanson MH, Fiorotto R, Duner E, Denson LA, Sanz JM, Di Virgilio F, Okolicsanyi L, Casagrande F, Strazzabosco M: \u003cstrong\u003eProinflammatory cytokines inhibit secretion in rat bile duct epithelium\u003c/strong\u003e. \u003cem\u003eGastroenterology \u003c/em\u003e2001, \u003cstrong\u003e121\u003c/strong\u003e(1):156-169.\u003c/li\u003e\n\u003cli\u003eLavillegrand JR, Mercier-Des-Rochettes E, Baron E, P\u0026egrave;ne F, Contou D, Favory R, Pr\u0026eacute;au S, Galbois A, Molliere C, Miailhe AF\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eAcute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study\u003c/strong\u003e. \u003cem\u003eCritical care (London, England) \u003c/em\u003e2021, \u003cstrong\u003e25\u003c/strong\u003e(1):49.\u003c/li\u003e\n\u003cli\u003eKhoury T, Sbeit W: \u003cstrong\u003eDiabetes mellitus is associated with a higher rate of acute cholangitis among patients with common bile duct stones: A retrospective study\u003c/strong\u003e. \u003cem\u003eMedicine \u003c/em\u003e2022, \u003cstrong\u003e101\u003c/strong\u003e(4):e28687.\u003c/li\u003e\n\u003cli\u003eRoehlen N, Roca Suarez AA, El Saghire H, Saviano A, Schuster C, Lupberger J, Baumert TF: \u003cstrong\u003eTight Junction Proteins and the Biology of Hepatobiliary Disease\u003c/strong\u003e. \u003cem\u003eInternational journal of molecular sciences \u003c/em\u003e2020, \u003cstrong\u003e21\u003c/strong\u003e(3).\u003c/li\u003e\n\u003cli\u003eP\u0026ouml;tter-Lang S, Ba-Ssalamah A, Bastati N, Messner A, Kristic A, Ambros R, Herold A, Hodge JC, Trauner M: \u003cstrong\u003eModern imaging of cholangitis\u003c/strong\u003e. \u003cem\u003eThe British journal of radiology \u003c/em\u003e2021, \u003cstrong\u003e94\u003c/strong\u003e(1125):20210417.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute cholangitis, Choledocholithiasis, ERCP, Charcot’s triad, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-4207354/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4207354/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAcute cholangitis, an acute and severe disease in the clinic, is mostly caused by choledocholithiasis. This study aimed to identify the predictive factors for developing acute cholangitis due to choledocholithiasis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 558 patients with choledocholithiasis were enrolled. The patients were divided into a choledocholithiasis group (n\u0026thinsp;=\u0026thinsp;399) and an acute cholangitis group (n\u0026thinsp;=\u0026thinsp;159) according to whether they had acute cholangitis. The clinical data were analyzed, and logistic regression was used to predict acute cholangitis. Receiver operating characteristic (ROC) curves were generated to identify predictive factors for acute cholangitis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe acute cholangitis group had a greater prevalence of male sex, age\u0026thinsp;\u0026ge;\u0026thinsp;70 years, smoking history, hypertension, fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills, duodenal peripapillary diverticulum, and maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm). Furthermore, the acute cholangitis group had higher WBC, CRP, T-Bil, ALT, AST, ALP, GGT, serum creatinine (Scr), prothrombin time (PT) and D-dimer (D-D) levels and lower albumin levels. Logistic regression analysis revealed that the maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm), T-Bil, CRP, WBC, fever (\u0026gt;\u0026thinsp;38\u0026deg;C) and/or shaking chills, male sex, AST, and ALP were independent risk factors for developing acute cholangitis, with an area under the ROC curve (AUC) of 0.869 for CRP, 0.858 for T-Bil, 0.835 for WBC, 0.765 for AST and 0.743 for ALP.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAttention should be given to choledocholithiasis patients who have a maximum diameter of choledocholithiasis (\u0026ge;\u0026thinsp;10 mm), T-Bil\u0026thinsp;\u0026gt;\u0026thinsp;34.25 \u0026micro;mol/L, CRP\u0026thinsp;\u0026gt;\u0026thinsp;10.85 mg/L, WBC\u0026thinsp;\u0026gt;\u0026thinsp;9.95\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L, fever (\u0026gt;\u0026thinsp;38℃) and/or shaking chills, male sex, ALP\u0026thinsp;\u0026gt;\u0026thinsp;162.5 U/L and AST\u0026thinsp;\u0026gt;\u0026thinsp;57.8 U/L. Interventions may be taken to prevent acute cholangitis.\u003c/p\u003e","manuscriptTitle":"Predictive factors for developing acute cholangitis due to choledocholithiasis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-09 12:55:24","doi":"10.21203/rs.3.rs-4207354/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"225071c6-51d5-4cf0-87d9-d7c9379717e0","owner":[],"postedDate":"April 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-21T19:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-09 12:55:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4207354","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4207354","identity":"rs-4207354","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}