Clinical Profile, Management and Outcomes of Acute Cholangitis: 5 Years Experience at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Clinical Profile, Management and Outcomes of Acute Cholangitis: 5 Years Experience at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia | 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 Clinical Profile, Management and Outcomes of Acute Cholangitis: 5 Years Experience at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia Gemeda Nebi Edasu, Abigael Abiy Mesfin, Samuel Zerihun Tesfaye, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8412335/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Acute cholangitis is an acute inflammation and infection within the biliary tree that is usually secondary to mechanical obstruction, such as choledocholithiasis, malignant biliary obstruction, benign strictures, ampullary or duodenal obstruction, and stent blockade or dysfunction of the sphincter of Oddi. Accurate and up-to-date epidemiological data concerning acute cholangitis are relatively scarce, especially in sub-Saharan African countries. This study on the clinical profile and management of acute cholangitis holds significant importance for both clinical practice and public health by characterizing the clinical presentation and demographic features of patients with acute cholangitis. Methods The study was conducted at Tikur Anbessa Specialized Hospital, the largest healthcare facility in Ethiopia, which is located in Addis Ababa. The study covered a five-year period, from January 2020 to December 2024. A hospital-based retrospective study was conducted. Data were obtained from the medical records of patients (charts) diagnosed with cholangitis. Bivariable and multivariable logistic regression were used, and statistical significance was set at a p value < 0.05 to compare independent variables with outcomes. Results The medical records of 81 patients with a diagnosis of acute cholangitis fulfilling the inclusion criteria were included in the study. The mean age of the patients was 53.96 years, and 56.8% were female. The most common etiology was choledocholithiasis (50.6%). Jaundice (95.1%) and RUQ-related abdominal pain (71.6%) were the most common presenting symptoms. Medical management alone was successful in 85.2% of the patients. Adverse outcomes, including liver abscess, intensive care unit (ICU) admission, and two deaths (2.5%), occurred in 21% of patients. Multivariate analysis revealed that age, weight loss, pulse rate, platelet count, albumin level, and prothrombin time were predictors of poor outcomes. The serum ALB concentration and PT were also associated with higher severity scores. Conclusion Acute cholangitis in this setting is primarily due to choledocholithiasis and presents late. Outcomes are generally favorable, but gaps exist in microbiologic testing and early intervention. The incorporation of the TG13 criteria for diagnosis and grading, improved access to endoscopic therapy, and early risk stratification via clinical and laboratory markers are essential for optimizing care. Acute cholangitis clinical profile Ethiopia management Figures Figure 1 Figure 2 INTRODUCTION Acute cholangitis is an acute inflammation and infection within the biliary tree that is usually secondary to mechanical obstruction, such as choledocholithiasis, malignant biliary obstruction, benign strictures, ampullary or duodenal obstruction, and stent blockade or dysfunction of the sphincter of Oddi. It ranges in severity from a mild form, with fever and jaundice, to a severe form with septic shock( 1 ). Persistent or partial obstruction to the biliary tree causes increased intraductal pressure, which eventually leads to the reflux of bacteria from the duodenum to the venous and lymphatic systems. The translocation of bacteria into the bloodstream results in septicemia, an often fatal complication of acute cholangitis( 2 , 3 ). The causes of biliary tree obstruction in greater than 85% of cases are attributed to bile duct stones, malignancies and benign strictures ( 4 – 6 ). In the presence of obstruction, the bile is colonized, and bacteria proliferate, causing infection. The most common etiologies retrieved from bile and blood cultures are E. coli , Klebsiella spp. and Bacteroides spp. ( 7 , 8 ). Globally, the annual incidence is 28 cases per 100 000 individuals( 18 ). The incidence is greater in regions with a high prevalence of gallstone disease. Up to 9% of patients admitted to the hospital with gallstone disease have acute cholangitis. The median age ranged from 50–60 years. It is more common in males than in females ( 13 ). However, bacterial infection, the key catalyst for AC, can be promoted by several factors( 20 ). The triad of jaundice, fever and abdominal pain, termed Charcot’s triad, has been used for a very long time to diagnose acute cholangitis. The triad remains pathognomonic for identifying cholangitis and has a specificity of 85%, yielding a sensitivity of approximately 25% ( 9 , 10 ). Findings of hypotension and altered mental status are observed in only 5%–7% of cases but typically represent more severe disease( 11 ). Fever in isolation has been reported to have a sensitivity between 40% and 100%, whereas abdominal pain alone has a sensitivity between 60% and 100%; however, a lack of specificity makes fever and abdominal pain alone poor diagnostic criteria( 12 ). However, in recent studies, its diagnostic sensitivity was poor, and it is no longer used as a diagnostic criterion. Since 2007, the Tokyo guidelines have been used to classify and provide severity-based interventions worldwide. The guidelines were updated in 2013 and 2018 for better diagnostic sensitivity. Features of systemic inflammation, cholestasis and imaging findings were used in combination to diagnose AC according to the guidelines. A definitive diagnosis of the disease is made if a feature is found from systemic inflammation, cholestasis, and imaging. The diagnosis of suspected AC is made if one item from systemic inflammation and one item from either cholestasis or imaging are present. The diagnostic sensitivity of TG13 is approximately 90% ( 13 – 15 ). The management of acute cholangitis includes immediate resuscitation and stabilization of the patient, antibiotics, decompression of the biliary tree, and definitive therapy. There is a consensus that patients with acute cholangitis should receive broad-spectrum antibiotics, and other measures should not be delayed while waiting for a definitive diagnosis. Organisms that produce common biliary tract infections are the main etiologic agents of AC: E. coli , Klebsiella, Enterobacter, and Bacteroides. Antibiotic coverage of the organisms obtained from cultures is crucial to achieve good results in the management of patients for the most appropriate antibiotic treatment ( 25 ). The only way to downstage severe AC is by biliary drainage with ERCP or PTC. ERCP is the first choice for biliary drainage in many cases. In patients with complications or persisting sepsis despite endoscopic intervention, PTC or operative biliary access is used( 13 , 23 , 26 , 27 ). Accurate and up-to-date epidemiological data concerning acute cholangitis are relatively scarce, especially in sub-Saharan African countries ( 31 ). The burden of acute cholangitis at Tikur Anbessa Specialized Hospital is notable because of the hospital's role as a tertiary referral center in Ethiopia. However, limited information exists on the clinical profile, management practices, and outcomes of patients treated for acute cholangitis. Challenges such as delayed presentation, resource constraints, limited access to advanced diagnostic and therapeutic modalities, and variability in clinical management protocols may contribute to suboptimal outcomes. The lack of local data further hampers the development of context-specific strategies for improving care delivery. This study sought to retrospectively analyze the clinical characteristics, etiologic factors, management approaches and outcomes of acute cholangitis patients at Tikur Anbessa Specialized Hospital. This study on the clinical profile and management of acute cholangitis holds significant importance for both clinical practice and public health by characterizing the clinical presentation and demographic features of patients with acute cholangitis. This study provides insights into the local disease burden, risk factors, management patterns, outcomes and trends specific to the studied population. Identifying common symptoms, laboratory findings and imaging results associated with acute cholangitis will help clinicians improve diagnostic accuracy and reduce delays in initiating treatment, thereby improving patient outcomes. This can guide the development of standard treatment protocols tailored to the local healthcare context. Data from this study can inform hospital administrators and policymakers about resource needs, such as improving access to diagnostic tools and therapeutic procedures, leading to better healthcare delivery for biliary tract diseases. This study provides a baseline for further research into acute cholangitis and related biliary conditions, including other types of studies to test interventions or preventive measures. By addressing these critical aspects, this study has the potential to increase the quality of care for patients with acute cholangitis and contribute to evidence-based improvements in healthcare practices and policies. Methods Study Area and Period The study was conducted at Tikur Anbessa Specialized Hospital, the largest healthcare facility in Ethiopia, which is located in Addis Ababa. It is a leading center for hepatopancreaticobiliary (HPB) services, provided by the HPB unit within the Department of Surgery, which includes five HPB surgeons and five HPB fellows during the study period. Given its diverse patient population and advanced diagnostic and therapeutic capabilities, the hospital offers an ideal setting for investigating the clinical profile and management of acute cholangitis. The study covered a five-year period, from January 2020 to December 2024. This timeframe allowed for a comprehensive analysis of patient data, diagnostic approaches and treatments related to acute cholangitis. Study Design A hospital-based retrospective study was conducted. Data were obtained from the medical records of patients (charts) diagnosed with cholangitis. Source population All patients who were diagnosed with acute cholangitis were treated at Tikur Anbessa Specialized Hospital during the study period. Study Population Patients who were admitted to the surgical ward for acute cholangitis at Tikur Anbessa Specialized Hospital during the study period met all the inclusion criteria. Inclusion and exclusion criteria Inclusion criteria All adults above the age of 18 years were admitted to the surgical ward at TASH for acute cholangitis during the study period. Exclusion criteria Patients with incomplete medical records Patients who were transferred to other facilities before completing treatment and did not return for follow-up. Patients who did not complete the treatment Patients with concurrent acute abdominal conditions (e.g., acute pancreatitis) that could confound the diagnosis or management of acute cholangitis Sample size determination and sampling technique The sample size was calculated via the single population proportion formula and the double population formula via epi-info calc software. Sample size for the first objective Variable Proportion Confidence level Margin of error Sample size No response Final sample size Reference Patients admitted to Surgical ward with diagnosis of Acute cholangitis 6% 95% 5% 87% 10% 96 (47) All patients who experienced cholangitis during the study period were included. Study Variables Dependent Variable Outcome of acute cholangitis (favorable or unfavorable) 4.8.2 Independent Variables Sociodemographic characteristics: Age, sex, and BMI Comorbidity Behavior: Smoking, alcohol consumption Clinical presentation: Symptoms, signs, and laboratory data Severity grading Operational definition Acute cholangitis–Disease patients were retrospectively diagnosed with acute cholangitis among all obstructive jaundice patients according to the TG13 diagnostic criteria. Definitive acute cholangitis – patients with systemic inflammation + evidence of cholestasis + imaging evidence of biliary obstruction. Suspected acute cholangitis - patients with systemic inflammation + evidence of cholestasis or imaging evidence of biliary obstruction Noncholangitis – cases fulfilling either criterion for definite or suspected acute cholangitis but treated as cases of acute cholangitis Mild acute cholangitis : Disease with criteria of neither moderate nor severe AC Moderate acute cholangitis was defined as follows: WBC count > 12000/mm 3 or 39 0 c, age >75 years, hyperbilirubinemia > 5 mg/dl, and hypoalbuminemia < 2.5 g/dl. Severe acute cholangitis : Patients with any organ failure Inadequate antimicrobial therapy - Either the administration of empiric antimicrobials that are inactive against subsequently isolated organisms or no administration of antimicrobial agents between drawing a blood culture and obtaining a positive culture result(45). Prolonged hospital stays: hospital stays greater than the 75 th percentile Favorable outcome - if the patient has no prolonged hospital stay or has complications such as liver abscess, intensive care unit (ICU) admission, in-hospital mortality, persistent organ failure, or 30-day mortality Unfavorable outcome - Patients with any of the above parameters (prolonged hospital stay, liver abscess, intensive care unit (ICU) admission, in-hospital mortality, persistent organ failure or 30-day mortality). Data collection methods Data were collected by two medical doctors working in the surgical ward of the selected hospitals via data collection questionnaires prepared by the research team. Training was given to the data collectors by the principal investigator for two days on the objective of the study, i.e., how to fill and collect the relevant data via the data collection sheet. The Principal Investigator continuously supervised the data collectors. Sociodemographic and other patient-related factors were extracted from patient medical charts. The patient card numbers were obtained from the regular OPD HMIS register and surgery department HMIS register. All patient cards were collected from the card office. Pretesting was performed in 5% of the questionnaire cases in the same study area by the principal investigator. The collected data were checked for completeness consistency and clarity. Data Processing and Analysis The collected data were checked for completeness, consistency, clarity, and missing values and were entered into EPI-info version 4.6. The cleaned and coded data were subsequently exported to SPSS version 25 for data management and further statistical analysis. Frequency counts were performed to assess the completeness of all variables. 95% confidence intervals were used to correlate the outcome variable with its independent variable. Bivariable and multivariable logistic regression were used, and statistical significance was set at a p value < 0.05 to compare independent variables with outcomes. Ethics approval and consent to participate The proposal was submitted to advisors for feedback and approval before conducting the study. Ethical approval for this study was obtained from the Research and Ethical Review Committee of the Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia (reference number: DOS/REC/137/2025/2017). Permission to access patient medical records was granted by the hospital administration and the outpatient department. This study was conducted as a retrospective chart review using routinely collected clinical data with no direct patient contact. The requirement for informed consent was waived by the Research and Ethical Review Committee due to the retrospective nature of the study, the use of anonymized data, minimal risk to participants, and the impracticability of obtaining consent from all patients included over the five-year study period. The information collected from the study subjects was kept confidential and was used only for the study. The study was conducted in accordance with the principles of the Declaration of Helsinki. Results Sociodemographic characteristics The medical records of 81 patients with a diagnosis of acute cholangitis fulfilling the inclusion criteria were included in the study. The mean age of the participants was 53.96 years, with a range from 22--81 years. The largest proportion of patients (37.0%) were aged between 41 and 60 years, followed closely by those older than 60 years. More than half of the participants were female (56.8%), whereas 43.2% were male. With respect to place of residence, the majority of patients (64.2%) were from urban areas, whereas 35.8% lived in rural settings (Table 1). The prevalence of comorbidities in our study was approximately 28.4%. The most common comorbidities identified were hypertension, diabetes mellitus, and retroviral infection (HIV), each contributing to 48%, 43%, and 13% of the comorbidities, respectively. The remaining comorbidities identified were bronchial asthma, cardiac diseases, chronic kidney disease, COPD and epilepsy. Table 1 . Sociodemographic characteristics and comorbidities , Addis Ababa, 2025 Variable Total (%) Retrospective severity grade of acute cholangitis according to Tokyo Guideline I(%) II(%) III(%) Age in years 21-40 21(25.9) 18(85.7) 3(14.3) 0 41-60 30(37) 19(63.3) 10(33.3) 1(3.3) >60 30(37) 17(56.7) 8(26.7) 5(16.7) Gender Male 35(43.2) 24(68.6) 10(28.6) 1(2.9) Female 46(56.8) 30(65.2) 11(23.9) 5(10.9) Residency Urban 52(64.2) 34(66.7) 14(27.5) 4(7.7) Rural 29(35.8) 20(69) 7(24.1) 2(639) Comorbidity Yes 23(28.4) 3(13) 14(60.9) 6(26.1) No 58(71.6) 51(87.9) 7(12.1) 0 Etiologies of Acute Cholangitis The underlying causes of cholangitis were categorized as either benign or malignant. Benign etiologies accounted for 59.3% of the cases, whereas 40.7% were due to malignant conditions. The most common specific cause was choledocholithiasis, which was identified in nearly half of the patients (50.6%), as shown in Figure 1. Other common causes include periampullary cancer, pancreatic head tumors, and cholangiocarcinoma in various anatomical locations. A prior history of biliary tract disease or intervention was noted in 12.3% of patients, most commonly cholecystectomy. The majority (87.7%) had no such prior history (Table 2). Table 2: Etiologies of Acute Cholangitis, Addis Ababa, 2025 Previous history of biliary disease Total (%) Grade I Grade II Grade III Yes 10(12.3) 5(50) 3(30) 2(20) No 71(87.7) 49(69) 18(25.4) 4(5.6) Types of biliary disease (n=10) Acute Cholangitis 2(20) 2 0 0 Acute Cholecystitis 1(10) 1 0 0 Bile duct stricture 4(40) 1 1 2 Cholecystectomy 3(30) 1 2 0 Types of tumors Benign 48(59.3) 33(68.8) 11(22.9) 4(8.3) Malignant 33(40.7) 21(63.6) 10(30.3) 2(6.1) Clinical presentation of the study participants The most common presenting symptom was jaundice, which was mentioned by 95.1% of the patients. Other frequent symptoms included right upper quadrant (RUQ) abdominal pain (71.6%), vomiting (56.8%), loss of appetite (56.8%), and dark-colored urine (61.7%). Less common symptoms included pruritus, itching, and changes in mental status. The mean hospital stay was 17.14 days, with a range of 3--58 days. With ≥23 days, representing the 75th percentile cutoff, 25.9% of patients had prolonged hospital stays (Table 3). Table 3: Clinical presentation of patients, Addis Ababa, 2025 Variable Total (%) Retrospective severity grade of acute cholangitis I(%) II(%) III(%) Presenting symptoms Jaundice 77(95.1) 52(67.5) 19(24.7) 6(7.8) Fever 25(30.9) 18(72) 3(12) 4(16) Right upper quadrant pain 58(71.6) 40(69) 15(25.9) 3(5.2) Dark color urine 50(61.7) 34(68) 14(28) 2(4) Vomiting 46(56.8) 26(56.5) 16(34.8) 4(8.7) Nausea 34(42) 17(50) 13(38.2) 4(11.8) Pruritus 11(13.6) 6(54.5) 2(18.2) 3(27.3) Pale and clay color stool 27(33) 18(66.7) 7(25.9) 2(7.4) Loss of appetites 46(56.8) 29(63) 13(28.3) 4(8.7) Weight loss 24(29.6) 13(54.2) 8(33.3) 3(12.5) Itching loss 13(16) 12(92.3) 1(7.7) 0 Chills or rigor 7(8.6) 4(57.1) 3(42.9) 0 Easly fatigability 4(4.9) 3 1 0 Mental status change 1(1.2) 0 0 1 General body swelling 1(1.2) 0 1 0 Duration of symptoms 0(0) 0 0 0 7days 60(74.1) 42(70) 15(25) 3(5) Pulse rate per minute 60-100 67(82.7) 48(71.6) 16(23.9) 3(4.5) >100 14(17.3) 6(42.9) 5(35.7) 3(21.4) Blood pressure Normotensive 67(82.7) 48(71.6) 17(25.4) 2(3) Hypotensive 7(8.6) 1(14.3) 2(28.6) 4(57.1) Hypertensive 7(8.6) 5(71.4) 2(28.6) 0 Temperature 35.6-37.2 77(95.1) 52(67.5) 19(24.7) 6(7.8) >37.2 4(4.9) 2(50) 2(50) 0 Oxygen saturation 90 62(76.5) 42(67.7) 17(27.4) 3(4.8) Abdominal tenderness Yes 42(51.9) 25(59.5) 14(33.3) 3(7.1) No 39(48.1) 29(74.4) 7(17.9) 3(7.7) Charcot` Triad Yes 15(18.5) 11(73.3) 2(13.3) 2(13.3) No 66(81.5) 43(65.2) 19(28.8) 4(6.1) Reynold`s Pentad 1(1.2) 1(100%) The pulse rate of the participants ranged from 60 to 125 beats per minute (bpm), with a mean of 88.2 bpm. Most patients (82.7%) had a normal pulse rate (60–100 bpm), whereas 17.3% had tachycardia. Among the 45 patients whose respiratory rates were recorded, the mean rate was 20 breaths per minute. The systolic BP ranged from 50 to 165 mmHg, with a mean of 112.3 mmHg. The diastolic BP ranged from 40 to 100 mmHg, with a mean of 70.0 mmHg. Most patients (95.1%) were afebrile, with temperatures in the 35.6–37.2°C range. Only 4.9% had fever (>37.2°C). The mean SpO₂ was 90.9% (±6.2). Approximately 23.5% of patients had oxygen saturation <90%, indicating hypoxemia. On examination, 51.9% of patients presented with abdominal tenderness, whereas the remaining 48.1% had no such findings. The triad of acute cholangitis (Charcot’s Triad) was observed in 18.5% of cases, whereas the Reynold’s pentad was recorded in only one patient. Laboratory Results The mean WBC count was 14,264/mm³, ranging from 2,930 to 114,000/mm³. The mean Hb concentration was 12.43 g/dL. The values ranged from 7.2 to 20.5 g/dL. The mean platelet count was 322,099/mm³, while most patients (96.3%) had platelet counts >150,000/mm³. The mean total bilirubin was 12.3 mg/dL, ranging from 0.58 to 45.97 mg/dL. The mean direct bilirubin level was 7.57 mg/dL. ALT ranged from 10 to 1,472 U/L, with a mean of 187 U/L. AST values widely varied, with a mean of 306.6 U/L and a maximum of 8,380 U/L. ALP ranged from 54 to 8,662 U/L, with a mean of 770 U/L. Serum ALB levels were available for all patients. The mean albumin level was 3.73 g/dL, with a range of 1.7–6.0 g/dL. Approximately 42% of patients had albumin levels <3.5 g/dL, indicating potential hypoalbuminemia (Table 4). Table 4: Laboratory results of the study participants, Addis Ababa, 2025 Variable level Total Retrospective severity grade of acute cholangitis I(%) II(%) III(%) WBC/mm3 18000 17(21) 3(17.6) 11(64.7) 3(17.6) Platelet count 100,000-150,000 3(3.7) 2(66.7) 0 1(33.3) ≥150000 78(96.3) 52(66.7) 21(26.9) 5(6.4) Total bilirubin 20 22(27.2) 13(59.1) 7(31.8) 2(9.1) Direct bilirubin <3 28(34.5) 23(82.1) 3(10.7) 2(7.1) 3-7.99 18(22.2) 10(55.6) 7(39.9) 1(5.6) 8-15 25(30.9) 16(64) 8(32) 1(4) ≥15 10(12.3) 5(50) 3(30) 2(20) ALT normal 21(25.9) 16(76.2) 3(14.3) 2(9.5) 2folds 20(24.7) 14(70) 5(25) 1(5) 3folds 18(22.2) 8(44.4) 9(50) 1(5.6) ≥4folds 22(27.2) 16(72.7) 4(18.2) 2(9.1) AST normal 14(17.3) 13(92.9) 1(7.1) 0 2folds 18(22.2) 11(61.1) 6(33.3) 1(5.6) 3folds 21(25.9) 12(57.1) 7(33.3) 2(9.5) ≥4folds 28(34.6) 18(64.3) 7(25) 3(10.7) ALP normal 22(27.2) 16(72.7) 5(22.7) 1(4.5) 2folds 16(19.8) 7(43.8) 8(50) 1(6.3) 3folds 6(7.4) 6(100) 0 0 ≥4folds 37(45.7) 25(67.6) 8(21.6) 4(10.8) Albumin (g/dl) 3.5 47(58) 36(76.6) 10(21.3) 1(2.1) CRP (mg/L) (n=13) 5 12(92.3) 6(50) 3(25) 3(25) ESR (n=5) 20 2(40) 0( 2(100) 0 Serum creatinine (mg/dl) 1.3 5(6.2) 1(20) 0 4(80) BUN (mg/dl) 30 13(16) 10(76.9) 2(15.4) 2(7.7) INR 3.5 2(2.5) 1(33.3) 1(50) 0 PT 13 38(46.3) 26(68.4) 7(18.4) 5(13.2) PTT 35 17(21) 10(58.8) 5(29.4) 2(11.8) Serum potassium 5 4(5.1) 2(50) 2(50) 0 Serum sodium 145 2(2.5) 0 1(50) 1(50) Serum chloride 105 19(24.7) 12(63.2) 4(21.1) 3(15.8) CRP was markedly elevated in patients with high CRP levels (13 patients). The majority (84%) had a value of 68 mg/L, which reached as high as 7,200 mg/L. ESR values were recorded for only 5 patients. Among them, 60% had an ESR 20 mm/hr. The mean creatinine level was 0.83, with a maximum value of 5.62 mg/dL. Most patients (93.8%) had creatinine levels 30 mg/dL. The mean INR was 1.30, with values ranging from 0.85 to 5.00. Approximately 86.4% had an INR 13 seconds. The aPTT ranged from 13.9 to 377 seconds, with a mean of 34.09 seconds. Approximately 21% had elevated aPTT (>35 s). The mean potassium concentration was 5.88 mmol/L. A total of 35.8% were hypokalemic (5). The mean sodium concentration was 134.6 ± 15.82 mmol/L. Nearly all the values fell within the normal range (135–145). The mean chloride level was 101.5, ranging from 85 to 115 mmol/L. A total of 70.1% had normal values (95–105 mmol/L), 5.2% were hyperchloremic (105 mmol/L). Among the 81 patients, only 4.9% had a culture test performed. Among these samples, the only sample type recorded was blood culture. For microorganism identification, Escherichia coli was isolated from 1 patient (1.2%) (Table 5). Table 5: Cultures and microorganisms, Addis Ababa, 2025 Variable frequency Percent Culture performed Yes 4 4.9 No 77 95.1 Types of culture Blood 4 100 Isolated microorganism E. coli 1 25 None 1 25 Not documented 2 50 Imaging modalities The imaging modalities used were abdominal ultrasound (US), computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP). Abdominal ultrasound was used as the initial imaging modality in all the patients. Approximately 81.5% of the cases were further investigated via either CT scan or MRCP. Approximately 15% of patients had only biliary dilation as evidence of obstruction, while the etiologies of the remaining patients were identified preoperatively. The majority of the latter were those who had only abdominal US as the sole imaging modality. Severity and Diagnosis According to the TG13 Criteria All patients had a recorded diagnosis of acute cholangitis. When TG13 was applied retrospectively, 70.4% of patients were reclassified as definite acute cholangitis, 17.3% as suspected cholangitis, and 12.3% as noncholangitis. Severity grading revealed that 50.6% were classified as Grade I (mild), whereas 25.9% and 6.2% were Grade II and III, respectively. The severity of disease in 17.3% of the patients was not recorded. Approximately 69.1%, 23.5%, and 7.4% were reclassified as Grade I, Grade II, and Grade III, respectively. The positive predictive value (PPV) of the recorded diagnosis compared with that of TG13 was 85.1%. Severity grading via TG13 also revealed differences from the recorded assessments. The PPV for Grade I disease was 95.1%, the PPV for Grade II disease was 66.7%, and the PPV for Grade III disease was 80.0% (Table 6). Table 6: Retrospective severity grading according to TG13 Variables Retrospective severity grading Total I(%) II(%) III(%) Recorded severity grade Grade I 41 39(95.1) 1(2.4) 1(2.4) Grade II 21 6(28.6) 14(66.7) 1(4.8) Grade III 5 0 1(20) 4(80) Not recorded 14 11(78.6) 3(21.4) 0 Retrospective diagnosis according TG13 Definitive AC 57 32(56.1) 19(33.3) 6(10.5) Noncholangitis 10 10(100) 0 0 Suspected AC 14 10(100) 0 0 Management of Acute Cholangitis Initial Management and Response The most common initial interventions included fluid resuscitation, antibiotics, and pain management (70.4%). All patients received ceftriaxone and metronidazole. The majority (85.2%) improved with initial therapy (Table 7). Table 7. Initial Management of patients Initial Management Frequency Percentage Fluid, antibiotics, pain management 57 70.4% Fluid, antibiotics, pain, nutritional support 15 18.5% Fluid + antibiotics 9 11.1% Emergency Interventions Twelve patients received emergency interventions. Additionally, 84.0% of patients required further definitive surgical management. Six patients received emergency surgical interventions: four patients underwent ERCP, and 2 patients underwent percutaneous transhepatic cholangiography (PTC). Definitive and palliative management Among the 81 patients, 72 (88.9%) required either definitive or palliative intervention. The most common procedures were cholecystectomy with CBDE, triple bypass, Whipple’s procedure and hepaticojejunostomy (Table 8). Table 8. Types of definitive management of patients Type of Definitive Management n % Cholecystectomy + CBDE 30 41.6% Biliary-enteric bypass 17 23.6% Whipple’s procedure 9 12.5% Cholecystectomy alone 4 5.5% Hepaticojejunostomy 6 8.3% Others (Gastrojejunostomy, Shunt, PTC etc.) 6 8.3% Outcomes, Complications, and Length of Stay Approximately 60% of patients had favorable outcomes. The remaining 40% either developed complications or had prolonged hospital stays (which were >= 23 days in our study), as shown in Figure 2. Overall, 19.8% of patients developed complications. These included liver abscess, intensive care unit (ICU) admission, persistent organ failure, hospital mortality, and 30-day mortality (Table 9). Table 9. Management outcomes of patients with acute cholangitis Variable Frequency Percent (%) Management outcomes of the patients · Developed complications 16 19.7 · Improved and discharged 65 80.3 The list of complication (n=16) · 30-day Mortality 1 5.9 · ICU admission 5 29.4 · ICU admission, Persistent Organ Failure, In hospital Mortality 1 5.9 · In hospital Mortality 2 11.8 · liver abscess 7 41.2 · Persistent Organ Failure 1 5.9 Duration of hospital stay · <23 62 76.5% · ≥23 19 23.5% Factors associated with adverse outcomes of acute cholangitis Bivariate logistic regression analyses were conducted to explore the relationships between various demographic and clinical variables and adverse outcomes in patients with acute cholangitis. Initially, bivariate logistic regression was run, and a cutoff of 0.2 was used to screen for variables potentially associated with adverse outcomes of acute cholangitis. Variables that were eligible for inclusion were further entered into the multivariable logistic regression. In this study, age, loss of appetite, weight loss, comorbidities and retrospective grading were significantly associated with the outcome of AC according to bivariate binary logistic regression. Multivariate logistic regression analysis revealed that individuals over 60 years of age had a fourfold increased risk of experiencing an unfavorable outcome of AC compared with those aged 21–40 years (AOR = 4.0, 95% CI: 1.89–18.00). Similarly, those who reported weight loss had 4.3 times greater odds of an unfavorable outcome than those without weight loss (AOR = 4.3, 95% CI: 1.94–19.40). Furthermore, individuals with comorbidities were 3.4 times more likely to have an unfavorable outcome than those without comorbid conditions were (AOR = 3.4, 95% CI: 1.55–21.03). Variable Outcome of acute cholangitis p value COR with 95%CI P Value AOR with 95%CI unfavorable favorable Age in years 21-40 5 16 1 1 41-60 11 19 0.333 1.9(0.53, 6.46) 0.914 0.92(0.20, 4.20) >60 18 12 0.013 4.8(1.39, 16.62) 0.049 4.0(1.89, 18.00) Residency Urban 18 34 1 1 rural 16 13 0.075 2.3(0.92, 5.88) 0.599 1.4(0.37, 5.59) Dark urine color No 9 22 1 1 yes 25 25 0.066 2.4(0.94, 6.34) 0.401 1.8(0.46, 7.06) Loss of appetite No 8 27 1 1 yes 26 20 0.003 4.4(1.64, 11.70) 0.236 2.2(0.59, 8.05) Weight loss No 17 40 1 1 yes 17 7 0.001 5.7(2.00, 16.29) 0.040 4.3(1.94, 19.40) Comorbidity No 20 38 1 1 yes 14 9 0.033 2.9(1.09, 8.01) 0.018 3.4(1.55, 21.03) Albumin 3.5 17 30 1 1 Retrospective severity grade Grade I 18 36 1 1 Grade II 11 10 0.028 2.9(1.12, 7.55) 0.855 0.85(0.151, 4.81) Grade III 5 1 DISCUSSION In our study, we described the clinical profile, investigations and management of patients who had acute cholangitis for more than five years. Our participants had an average age of 53.96 years, with 56.8% females, which contrasts with many reports of acute cholangitis affecting older, male-predominant populations. For example, Kiriyama et al. reported a mean age of 72.2 years and a 59% male predominance in their multicenter study(40). A South Indian study similarly reported a male majority with a mean age of 51.7 years(6). However, in Indonesia, a slight female predominance of 51.6% (39) was reported, which was consistent with our findings. These findings could be attributed to the general predisposition of females to choledocholithiasis, which can also be found in old individuals, as diabetes is commonly found in old individuals and has been shown to increase the likelihood of acute cholangitis. Choledocholithiasis was the most common cause of cholangitis in our study (50.6%), which is in line with the literature, where bile duct stones account for 54% to over 60% of cases (4,6,39,40). Malignancy accounted for 40.7% of our cases, which is higher than in previous reports, such as Kiriyama's 15.6% (40) and Raghhupatruni's 17.1% (6). This discrepancy may reflect our hospital's tertiary referral status, with a greater burden of malignant obstructions. Jaundice (95.1%) and right upper quadrant pain (71.6%) were the most common presenting symptoms in our patients, in parallel with findings in previous studies that emphasized cholestasis and biliary obstruction as central to acute cholangitis presentation (8,36,37). Only 30.9% of our patients had fever, and the full Charcot triad was observed in only 18.5% of our patients, reinforcing its low sensitivity despite its high specificity (14,36). Kiriyama et al. also reported a similar diagnostic rate for Charcot's triad, with positivity in only 21.2% of the study participants included(40). This finding shows that decisions in the diagnosis of acute cholangitis cannot be based only on clinical manifestations. For our study participants, total bilirubin was >10 mg/dL in nearly half of the patients, with ALP ≥4-fold elevated in 45.7% and AST similarly increased. Coagulopathy was evident in 46.9% of the patients, with PTs >13 seconds. These findings are similar to those of prior studies identifying bilirubin, hypoalbuminemia, and the international normalized ratio (INR) as severity indicators(6, 40). Microbiological testing was severely limited; only 4.9% of cultures were performed. Studies on similar topics have shown that blood cultures are positive in 15.7% to 40% of cases and that bile cultures are positive in up to 83% of cases (8, 38). E. coli was isolated from our single culture-positive patient, which is consistent with global reports that listed E. coli and Klebsiella as the predominant pathogens (8, 38). The limited availability of culture results in our study could have impacted its representativeness. Our study revealed that all 81 patients were initially diagnosed with definite AC, but only 70.4% met the Tokyo Guidelines 2013 (TG13) criteria retrospectively. This overdiagnosis was also reported by Soares et al., who reported an initial recorded prevalence of 9.9%, which increased to 43% when the TG13 criteria were retrospectively applied (7). Similarly, Kiriyama et al. reported that 73.1% of cases fulfilled definite acute cholangitis criteria, whereas 16.9% were classified as suspected (40). This could be due to a high index of suspicion by the surgeon in order not to miss any patient who has the potential to be diagnosed with acute cholangitis. With respect to management,initial management with intravenous fluids, antibiotics (ceftriaxone and metronidazole), and pain control was administered to all patients, which is consistent with TG13 recommendations that prioritize early stabilization(13). In our study, 85.2% of the patients responded to medical therapy alone, which is consistent with the 70% rate reported in the literature(44). Only 14.8% of the patients required emergency intervention (ERCP, surgical drainage, or PTC). Surgical intervention was the most common definitive treatment, with cholecystectomy and common bile duct exploration performed in 35.8% of patients. This finding does not align with the literature, where ERCP was the predominant intervention in 79.1% of cases (45). The reliance on surgery may be due to the limited availability of endoscopic services in our setup. Age was significantly associated with both severity and adverse outcomes, supporting earlier studies that identified advanced age as a poor prognostic factor (40). Hypoalbuminemia, elevated PT, increased BUN, and tachycardia were also correlated with poor outcomes in our study. These findings are in line with previous work by Raghhupatruni et al. and Kiriyama et al., who linked an albumin concentration 1.2, and a CRP concentration >85.5 mg/L with severe acute cholangitis (6, 40). The multivariate analysis in our study revealed that weight loss, comorbidities, and loss of appetite were significantly associated with adverse outcomes, likely reflecting systemic illness and delayed presentation. Similarly, increased pulse rates and low albumin levels were associated with higher TG13 severity scores, confirming their use as bedside prognostic markers. This study emphasizes the need for the routine use of the TG13 criteria to ensure diagnostic accuracy. The inadequate use of microbiological testing and reliance on surgical rather than endoscopic management indicate areas for improvement. Early identification of patients at risk for severe disease via simple clinical and laboratory parameters can guide timely intervention, even in low-resource settings. CONCLUSION Acute cholangitis remains a common condition that can be treated with multiple management options. Our study revealed variables associated with acute cholangitis that could help us improve diagnosis. While the outcomes were generally favorable in this study, there is still room for improvement in terms of diagnostic accuracy, microbiological assessment, and early risk stratification. The adoption of guideline-based practices, especially the TG13 criteria, should be implemented to improve patient care. RECOMMENDATIONS In this study, we elucidated the factors that influence acute cholangitis, which provides insight into the best ways to diagnose acute cholangitis and the factors to consider. To improve outcomes in patients with acute cholangitis, we recommend the routine use of the Tokyo Guidelines for diagnosis, severity grading, and treatment planning. Expanding local capacity for endoscopic services and enhancing coordination across referring facilities would ensure prompt and appropriate management. Finally, we would like to call all stakeholders to use resources for the early diagnosis of acute cholangitis at different levels of the health system. Limitations This study was based on data from one hospital, which limits its generalizability. Retrospective data can be affected by gaps in record keeping and documentation. Furthermore, the retrospective study design limits inference on the cause‒effect relationship. Abbreviations AC Acute cholangitis ALT Alanine aminotransferase AST Aspartate aminotransferase ALP Alkaline phosphatase CBD Common bile duct CI Confidence interval CT Computed Tomography DB Direct bilirubin ERCP Endoscopic retrograde cholangiopancreatography GI Gastrointestinal ICU Intensive Care Unit IQR Interquartile range LFT Liver function test MRCP Magnetic Resonance Cholangiopancreatography OPD Outpatient Department OR Odds ratio PT Prothrombin time PTC Percutaneous transhepatic cholangiography RUQ Right Upper Quadrant SD Standard deviation SPSS Statistical Package for the Social Sciences TB Total bilirubin TG13 Tokyo Guidelines 2013 TG18 Tokyo Guidelines 2018 US Ultrasound WBC White blood cell (WBC) count Declarations Availability of data and materials The datasets used in this study are available from the corresponding author upon request. Human Ethics and Consent to Participate This study involved human participants through the use of secondary data obtained from medical records. Ethical approval was obtained from the Ethical Review Committee of the Department of Surgery, Tikur Anbessa Specialized Hospital, and a waiver of informed consent was granted as described above. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study has not received any form of funding, and expenses were covered by the authors. Authors' contributions GE wrote the proposal, ST collected the data and AM analyzed the data. AM and GE wrote the final manuscript. ZA reviewed and provided directions during the write-up process. Declaration of Generative AI and AI-assisted technologies in the writing process During the preparation of this work, the author used Curie to improve the language. 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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-8412335","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":577724892,"identity":"bee4811f-9188-4949-9395-ede607d91153","order_by":0,"name":"Gemeda Nebi Edasu","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Gemeda","middleName":"Nebi","lastName":"Edasu","suffix":""},{"id":577724893,"identity":"1e735829-dece-4811-aa25-1fa4d7015bbe","order_by":1,"name":"Abigael Abiy 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11:49:02","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":198120,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8412335/v1/d1d9fbe9e070fe5867a6619e.html"},{"id":100951044,"identity":"5ab3aa3f-605f-49e3-a7e8-1edb22428f8f","added_by":"auto","created_at":"2026-01-23 07:09:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20710,"visible":true,"origin":"","legend":"\u003cp\u003eEtiologies of Acute Cholangitis\u003c/p\u003e","description":"","filename":"Image1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8412335/v1/20fe051d4435839e4c200148.jpg"},{"id":100884734,"identity":"5e4f6e0c-2ff5-4628-9771-cd0dffcb1c85","added_by":"auto","created_at":"2026-01-22 11:49:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20436,"visible":true,"origin":"","legend":"\u003cp\u003eManagement outcome of acute cholangitis\u003c/p\u003e","description":"","filename":"Image2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8412335/v1/a03e16ee7d9a2ac4c7e45665.jpg"},{"id":100953061,"identity":"d245e1cb-dc14-45f5-8d09-c905587dc444","added_by":"auto","created_at":"2026-01-23 07:19:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1830242,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8412335/v1/2bccf004-03c4-4d57-8804-2ee1a8292af5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Profile, Management and Outcomes of Acute Cholangitis: 5 Years Experience at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAcute cholangitis is an acute inflammation and infection within the biliary tree that is usually secondary to mechanical obstruction, such as choledocholithiasis, malignant biliary obstruction, benign strictures, ampullary or duodenal obstruction, and stent blockade or dysfunction of the sphincter of Oddi. It ranges in severity from a mild form, with fever and jaundice, to a severe form with septic shock(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Persistent or partial obstruction to the biliary tree causes increased intraductal pressure, which eventually leads to the reflux of bacteria from the duodenum to the venous and lymphatic systems. The translocation of bacteria into the bloodstream results in septicemia, an often fatal complication of acute cholangitis(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The causes of biliary tree obstruction in greater than 85% of cases are attributed to bile duct stones, malignancies and benign strictures (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In the presence of obstruction, the bile is colonized, and bacteria proliferate, causing infection. The most common etiologies retrieved from bile and blood cultures are \u003cem\u003eE. coli\u003c/em\u003e, Klebsiella spp. and Bacteroides spp. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, the annual incidence is 28 cases per 100 000 individuals(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The incidence is greater in regions with a high prevalence of gallstone disease. Up to 9% of patients admitted to the hospital with gallstone disease have acute cholangitis. The median age ranged from 50\u0026ndash;60 years. It is more common in males than in females (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, bacterial infection, the key catalyst for AC, can be promoted by several factors(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe triad of jaundice, fever and abdominal pain, termed Charcot\u0026rsquo;s triad, has been used for a very long time to diagnose acute cholangitis. The triad remains pathognomonic for identifying cholangitis and has a specificity of 85%, yielding a sensitivity of approximately 25% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Findings of hypotension and altered mental status are observed in only 5%\u0026ndash;7% of cases but typically represent more severe disease(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Fever in isolation has been reported to have a sensitivity between 40% and 100%, whereas abdominal pain alone has a sensitivity between 60% and 100%; however, a lack of specificity makes fever and abdominal pain alone poor diagnostic criteria(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, in recent studies, its diagnostic sensitivity was poor, and it is no longer used as a diagnostic criterion. Since 2007, the Tokyo guidelines have been used to classify and provide severity-based interventions worldwide. The guidelines were updated in 2013 and 2018 for better diagnostic sensitivity. Features of systemic inflammation, cholestasis and imaging findings were used in combination to diagnose AC according to the guidelines. A definitive diagnosis of the disease is made if a feature is found from systemic inflammation, cholestasis, and imaging. The diagnosis of suspected AC is made if one item from systemic inflammation and one item from either cholestasis or imaging are present. The diagnostic sensitivity of TG13 is approximately 90% (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe management of acute cholangitis includes immediate resuscitation and stabilization of the patient, antibiotics, decompression of the biliary tree, and definitive therapy. There is a consensus that patients with acute cholangitis should receive broad-spectrum antibiotics, and other measures should not be delayed while waiting for a definitive diagnosis. Organisms that produce common biliary tract infections are the main etiologic agents of AC: \u003cem\u003eE. coli\u003c/em\u003e, Klebsiella, Enterobacter, and Bacteroides. Antibiotic coverage of the organisms obtained from cultures is crucial to achieve good results in the management of patients for the most appropriate antibiotic treatment (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The only way to downstage severe AC is by biliary drainage with ERCP or PTC. ERCP is the first choice for biliary drainage in many cases. In patients with complications or persisting sepsis despite endoscopic intervention, PTC or operative biliary access is used(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccurate and up-to-date epidemiological data concerning acute cholangitis are relatively scarce, especially in sub-Saharan African countries (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The burden of acute cholangitis at Tikur Anbessa Specialized Hospital is notable because of the hospital's role as a tertiary referral center in Ethiopia. However, limited information exists on the clinical profile, management practices, and outcomes of patients treated for acute cholangitis.\u003c/p\u003e \u003cp\u003eChallenges such as delayed presentation, resource constraints, limited access to advanced diagnostic and therapeutic modalities, and variability in clinical management protocols may contribute to suboptimal outcomes. The lack of local data further hampers the development of context-specific strategies for improving care delivery. This study sought to retrospectively analyze the clinical characteristics, etiologic factors, management approaches and outcomes of acute cholangitis patients at Tikur Anbessa Specialized Hospital.\u003c/p\u003e \u003cp\u003eThis study on the clinical profile and management of acute cholangitis holds significant importance for both clinical practice and public health by characterizing the clinical presentation and demographic features of patients with acute cholangitis. This study provides insights into the local disease burden, risk factors, management patterns, outcomes and trends specific to the studied population. Identifying common symptoms, laboratory findings and imaging results associated with acute cholangitis will help clinicians improve diagnostic accuracy and reduce delays in initiating treatment, thereby improving patient outcomes. This can guide the development of standard treatment protocols tailored to the local healthcare context.\u003c/p\u003e \u003cp\u003eData from this study can inform hospital administrators and policymakers about resource needs, such as improving access to diagnostic tools and therapeutic procedures, leading to better healthcare delivery for biliary tract diseases. This study provides a baseline for further research into acute cholangitis and related biliary conditions, including other types of studies to test interventions or preventive measures. By addressing these critical aspects, this study has the potential to increase the quality of care for patients with acute cholangitis and contribute to evidence-based improvements in healthcare practices and policies.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy Area and Period\u003c/p\u003e\n\u003cp\u003eThe study was conducted at Tikur Anbessa Specialized Hospital, the largest healthcare facility in Ethiopia, which is located in Addis Ababa. It is a leading center for hepatopancreaticobiliary (HPB) services, provided by the HPB unit within the Department of Surgery, which includes five HPB surgeons and five HPB fellows during the study period. Given its diverse patient population and advanced diagnostic and therapeutic capabilities, the hospital offers an ideal setting for investigating the clinical profile and management of acute cholangitis.\u003c/p\u003e\n\u003cp\u003eThe study covered a five-year period, from January 2020 to December 2024. This timeframe allowed for a comprehensive analysis of patient data, diagnostic approaches and treatments related to acute cholangitis.\u003c/p\u003e\n\u003cp id=\"_Toc203209424\"\u003eStudy Design\u003c/p\u003e\n\u003cp\u003eA hospital-based retrospective study was conducted. Data were obtained from the medical records of patients (charts) diagnosed with cholangitis.\u003c/p\u003e\n\u003cp id=\"_Toc203209425\"\u003eSource population\u003c/p\u003e\n\u003cp\u003eAll patients who were diagnosed with acute cholangitis were treated at Tikur Anbessa Specialized Hospital during the study period.\u003c/p\u003e\n\u003cp id=\"_Toc203209426\"\u003eStudy Population\u003c/p\u003e\n\u003cp\u003ePatients who were admitted to the surgical ward for acute cholangitis at Tikur Anbessa Specialized Hospital during the study period met all the inclusion criteria.\u003c/p\u003e\n\u003cp id=\"_Toc203209427\"\u003eInclusion and exclusion criteria\u003c/p\u003e\n\u003cp id=\"_Toc203209428\"\u003eInclusion criteria\u003c/p\u003e\n\u003cp\u003eAll adults above the age of 18 years were admitted to the surgical ward at TASH for acute cholangitis during the study period.\u003c/p\u003e\n\u003cp id=\"_Toc203209429\"\u003eExclusion criteria\u003c/p\u003e\n\u003cp\u003ePatients with incomplete medical records\u003c/p\u003e\n\u003cp\u003ePatients who were transferred to other facilities before completing treatment and did not return for follow-up.\u003c/p\u003e\n\u003cp\u003ePatients who did not complete the treatment\u003c/p\u003e\n\u003cp\u003ePatients with concurrent acute abdominal conditions (e.g., acute pancreatitis) that could confound the diagnosis or management of acute cholangitis\u003c/p\u003e\n\u003cp\u003eSample size determination and sampling technique\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated via the single population proportion formula and the double population formula via epi-info calc software.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"774\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eSample size for the first objective\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProportion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConfidence level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMargin of error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFinal sample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePatients admitted to Surgical ward with diagnosis of Acute cholangitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e(47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAll patients who experienced cholangitis during the study period were included.\u003c/p\u003e\n\u003cp id=\"_Toc203209431\"\u003eStudy Variables\u003c/p\u003e\n\u003cp id=\"_Toc203209432\"\u003eDependent Variable\u003c/p\u003e\n\u003cp\u003eOutcome of acute cholangitis (favorable or unfavorable)\u003c/p\u003e\n\u003cp\u003e4.8.2 Independent Variables\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSociodemographic characteristics: Age, sex, and BMI\u003c/li\u003e\n \u003cli\u003eComorbidity\u003c/li\u003e\n \u003cli\u003eBehavior: Smoking, alcohol consumption\u003c/li\u003e\n \u003cli\u003eClinical presentation: Symptoms, signs, and laboratory data\u003c/li\u003e\n \u003cli\u003eSeverity grading\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp id=\"_Toc203209434\"\u003eOperational definition\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcute\u0026nbsp;\u003c/strong\u003echolangitis\u0026ndash;Disease patients were retrospectively diagnosed with acute cholangitis among all obstructive jaundice patients according to the TG13 diagnostic criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitive acute cholangitis \u0026ndash;\u0026nbsp;\u003c/strong\u003epatients with systemic inflammation + evidence of cholestasis + imaging evidence of biliary obstruction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSuspected acute cholangitis\u003c/strong\u003e- patients with systemic inflammation + evidence of cholestasis or imaging evidence of biliary obstruction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNoncholangitis\u0026nbsp;\u003c/strong\u003e\u0026ndash; cases fulfilling either criterion for definite or suspected acute cholangitis but treated as cases of acute cholangitis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMild acute cholangitis\u003c/strong\u003e: Disease with criteria of neither moderate nor severe AC\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModerate acute cholangitis\u003c/strong\u003e was defined as follows: WBC count \u0026gt; 12000/mm\u003csup\u003e3\u0026nbsp;\u003c/sup\u003eor \u0026lt; 4000/mm3, high fever \u0026gt; 39 \u003csup\u003e0\u003c/sup\u003ec, age \u0026gt;75 years, hyperbilirubinemia \u0026gt; 5 mg/dl, and hypoalbuminemia \u0026lt; 2.5 g/dl.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSevere acute cholangitis\u003c/strong\u003e: Patients with any organ failure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInadequate antimicrobial therapy\u003c/strong\u003e - Either the administration of empiric antimicrobials that are inactive against subsequently isolated organisms or no administration of antimicrobial agents between drawing a blood culture and obtaining a positive culture result(45).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProlonged hospital stays:\u0026nbsp;\u003c/strong\u003ehospital stays greater than the 75\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFavorable outcome\u003c/strong\u003e- if the patient has no prolonged hospital stay or has complications such as liver abscess, intensive care unit (ICU) admission, in-hospital mortality, persistent organ failure, or 30-day mortality\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnfavorable outcome\u003c/strong\u003e- Patients with any of the above parameters (prolonged hospital stay, liver abscess, intensive care unit (ICU) admission, in-hospital mortality, persistent organ failure or 30-day mortality).\u003c/p\u003e\n\u003cp id=\"_Toc203209435\"\u003eData collection methods\u003c/p\u003e\n\u003cp\u003eData were collected by two medical doctors working in the surgical ward of the selected hospitals via data collection questionnaires prepared by the research team. Training was given to the data collectors by the principal investigator for two days on the objective of the study, i.e., how to fill and collect the relevant data via the data collection sheet. The Principal Investigator continuously supervised the data collectors. Sociodemographic and other patient-related factors were extracted from patient medical charts. The patient card numbers were obtained from the regular OPD HMIS register and surgery department HMIS register. All patient cards were collected from the card office. Pretesting was performed in 5% of the questionnaire cases in the same study area by the principal investigator. The collected data were checked for completeness consistency and clarity.\u003c/p\u003e\n\u003cp id=\"_Toc203209437\"\u003eData Processing and Analysis\u003c/p\u003e\n\u003cp\u003eThe collected data were checked for completeness, consistency, clarity, and missing values and were entered into EPI-info version 4.6. The cleaned and coded data were subsequently exported to SPSS version 25 for data management and further statistical analysis. Frequency counts were performed to assess the completeness of all variables. 95% confidence intervals were used to correlate the outcome variable with its independent variable. Bivariable and multivariable logistic regression were used, and statistical significance was set at a p value \u0026lt; 0.05 to compare independent variables with outcomes.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe proposal was submitted to advisors for feedback and approval before conducting the study. Ethical approval for this study was obtained from the Research and Ethical Review Committee of the Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia (reference number: DOS/REC/137/2025/2017). Permission to access patient medical records was granted by the hospital administration and the outpatient department. This study was conducted as a retrospective chart review using routinely collected clinical data with no direct patient contact. The requirement for informed consent was waived by the Research and Ethical Review Committee due to the retrospective nature of the study, the use of anonymized data, minimal risk to participants, and the impracticability of obtaining consent from all patients included over the five-year study period. The information collected from the study subjects was kept confidential and was used only for the study. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eSociodemographic characteristics\u003c/h2\u003e\n\u003cp\u003eThe medical records of 81 patients with a diagnosis of acute cholangitis fulfilling the inclusion criteria were included in the study. The mean age of the participants was 53.96 years, with a range from 22--81 years. The largest proportion of patients (37.0%) were aged between 41 and 60 years, followed closely by those older than 60 years. More than half of the participants were female (56.8%), whereas 43.2% were male. With respect to place of residence, the majority of patients (64.2%) were from urban areas, whereas 35.8% lived in rural settings (Table 1).\u003c/p\u003e\n\u003cp\u003eThe prevalence of comorbidities in our study was approximately 28.4%. The most common comorbidities identified were hypertension, diabetes mellitus, and retroviral infection (HIV), each contributing to 48%, 43%, and 13% of the comorbidities, respectively. The remaining comorbidities identified were bronchial asthma, cardiac diseases, chronic kidney disease, COPD and epilepsy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e. Sociodemographic characteristics and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecomorbidities\u003c/strong\u003e\u003cstrong\u003e, Addis Ababa, 2025\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eTotal (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003eRetrospective severity grade of acute cholangitis according to Tokyo Guideline\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eI(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eII(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eIII(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e21-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e21(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e18(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e41-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e30(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e19(63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026gt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e30(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e17(56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8(26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e35(43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e24(68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e46(56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e30(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrban\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e52(64.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e34(66.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14(27.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4(7.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e29(35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e20(69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(639)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23(28.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3(13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14(60.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6(26.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e58(71.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e51(87.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7(12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eEtiologies of Acute Cholangitis\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe underlying causes of cholangitis were categorized as either benign or malignant. Benign etiologies accounted for 59.3% of the cases, whereas 40.7% were due to malignant conditions. The most common specific cause was choledocholithiasis, which was identified in nearly half of the patients (50.6%), as shown in Figure 1. Other common causes include periampullary cancer, pancreatic head tumors, and cholangiocarcinoma in various anatomical locations. A prior history of biliary tract disease or intervention was noted in 12.3% of patients, most commonly cholecystectomy. The majority (87.7%) had no such prior history (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Etiologies of Acute Cholangitis, Addis Ababa, 2025\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious history of biliary disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eTotal (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eGrade I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eGrade II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eGrade III\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e10(12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e5(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e71(87.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e49(69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e18(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e4(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of biliary disease\u003c/strong\u003e (n=10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eAcute Cholangitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eAcute Cholecystitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eBile duct stricture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e4(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eCholecystectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e3(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of tumors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eBenign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e48(59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e33(68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11(22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e4(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003eMalignant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e33(40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e21(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10(30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2(6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eClinical presentation of the study participants\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe most common presenting symptom was jaundice, which was mentioned by 95.1% of the patients. Other frequent symptoms included right upper quadrant (RUQ) abdominal pain (71.6%), vomiting (56.8%), loss of appetite (56.8%), and dark-colored urine (61.7%). Less common symptoms included pruritus, itching, and changes in mental status. The mean hospital stay was 17.14 days, with a range of 3--58 days. With \u0026ge;23 days, representing the 75th percentile cutoff, 25.9% of patients had prolonged hospital stays (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3: Clinical presentation of patients, Addis Ababa, 2025\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 259px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetrospective severity grade of acute cholangitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eII(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIII(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003ePresenting symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eJaundice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e77(95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e52(67.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e19(24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6(7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e25(30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e18(72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eRight upper quadrant pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e58(71.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e40(69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e15(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eDark color urine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e50(61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e34(68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e14(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e46(56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e26(56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e16(34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eNausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e34(42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e17(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e13(38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003ePruritus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e11(13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e6(54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003ePale and clay color stool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e27(33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e18(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eLoss of appetites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e46(56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e29(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e13(28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eWeight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e24(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e13(54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eItching loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e13(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e12(92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eChills or rigor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e7(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eEasly fatigability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eMental status change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eGeneral body swelling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eDuration of symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026lt;24 hrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e3(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e1-3days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e5(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e4-7days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e10(12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e4(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026gt;7days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e60(74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e42(70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e15(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePulse rate per minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e60-100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e67(82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e48(71.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e16(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026gt;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e14(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e6(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eNormotensive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e67(82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e48(71.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eHypotensive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e7(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eHypertensive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e7(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e5(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eTemperature\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e35.6-37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e77(95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e52(67.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e19(24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6(7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026gt;37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eOxygen saturation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026lt;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e19(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e12(63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026gt;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e62(76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e42(67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17(27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eAbdominal tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e42(51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e25(59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e14(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e39(48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e29(74.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eCharcot` Triad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e15(18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e11(73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e66(81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e43(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e19(28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4(6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eReynold`s Pentad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe pulse rate of the participants ranged from 60 to 125 beats per minute (bpm), with a mean of 88.2 bpm. Most patients (82.7%) had a normal pulse rate (60\u0026ndash;100 bpm), whereas 17.3% had tachycardia. Among the 45 patients whose respiratory rates were recorded, the mean rate was 20 breaths per minute. The systolic BP ranged from 50 to 165 mmHg, with a mean of 112.3 mmHg. The diastolic BP ranged from 40 to 100 mmHg, with a mean of 70.0 mmHg. Most patients (95.1%) were afebrile, with temperatures in the 35.6\u0026ndash;37.2\u0026deg;C range. Only 4.9% had fever (\u0026gt;37.2\u0026deg;C). The mean SpO₂ was 90.9% (\u0026plusmn;6.2). Approximately 23.5% of patients had oxygen saturation \u0026lt;90%, indicating hypoxemia. On examination, 51.9% of patients presented with abdominal tenderness, whereas the remaining 48.1% had no such findings. The triad of acute cholangitis (Charcot\u0026rsquo;s Triad) was observed in 18.5% of cases, whereas the Reynold\u0026rsquo;s pentad was recorded in only one patient.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eLaboratory Results\u003c/h2\u003e\n\u003cp\u003eThe mean WBC count was 14,264/mm\u0026sup3;, ranging from 2,930 to 114,000/mm\u0026sup3;. The mean Hb concentration was 12.43 g/dL. The values ranged from 7.2 to 20.5 g/dL. The mean platelet count was 322,099/mm\u0026sup3;, while most patients (96.3%) had platelet counts \u0026gt;150,000/mm\u0026sup3;. The mean total bilirubin was 12.3 mg/dL, ranging from 0.58 to 45.97 mg/dL. The mean direct bilirubin level was 7.57 mg/dL. ALT ranged from 10 to 1,472 U/L, with a mean of 187 U/L. AST values widely varied, with a mean of 306.6 U/L and a maximum of 8,380 U/L. ALP ranged from 54 to 8,662 U/L, with a mean of 770 U/L. Serum ALB levels were available for all patients. The mean albumin level was 3.73 g/dL, with a range of 1.7\u0026ndash;6.0 g/dL. Approximately 42% of patients had albumin levels \u0026lt;3.5 g/dL, indicating potential hypoalbuminemia (Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4: Laboratory results of the study participants, Addis Ababa, 2025\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"555\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003elevel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 256px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetrospective severity grade of acute cholangitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eII(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIII(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eWBC/mm3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;4000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4000-12000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e35(43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e33(94.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12000-18000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e25(30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16(64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;18000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e17(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11(64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003ePlatelet count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e100,000-150,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026ge;150000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e78(96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e52(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e21(26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5(6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eTotal bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e32(39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e27(84.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3(9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5-9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e9(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e18(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e22(27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e13(59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7(31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eDirect bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e28(34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e23(82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3(10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3-7.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e18(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7(39.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e25(30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16(64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026ge;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e10(12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e21(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16(76.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e20(24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14(70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e18(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026ge;4folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e22(27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16(72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e14(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e13(92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e18(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e11(61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e21(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e12(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026ge;4folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e28(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18(64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3(10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e22(27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16(72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5(22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e16(19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7(43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026ge;4folds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e37(45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25(67.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e4(10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eAlbumin (g/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e11(13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6(54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3(27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.5-3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e23(28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16(69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e47(58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e36(76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCRP (mg/L) (n=13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e12(92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e6(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eESR (n=5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0(\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eSerum creatinine (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e76(93.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e53(69.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e21(27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5(6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eBUN (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e68(84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e44(64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19(27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e13(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10(76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2(15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eINR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e70(86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e49(70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19(27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.5-2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.0-3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003ePT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e43(53.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e28(65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e14(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e38(46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e26(68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7(18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003ePTT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e64(79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e44(68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e16(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e4(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e17(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10(58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5(29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eSerum potassium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e29(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16(55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11(37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3.5-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e45(57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e34(75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e4(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4(5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eSerum sodium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e35-145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e75(92.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e52(69.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e18(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eSerum chloride\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e95-105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e54(70.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e35(64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e16(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e19(24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e12(63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCRP was markedly elevated in patients with high CRP levels (13 patients). The majority (84%) had a value of 68 mg/L, which reached as high as 7,200 mg/L. ESR values were recorded for only 5 patients. Among them, 60% had an ESR \u0026lt;20 mm/hr, and 40% had an ESR \u0026gt;20 mm/hr. The mean creatinine level was 0.83, with a maximum value of 5.62 mg/dL. Most patients (93.8%) had creatinine levels \u0026lt;1.3 mg/dL. The BUN values were highly variable, ranging from 6.2 to 215 mg/dL. The mean was 26.95 mg/dL, and 16% of patients had a BUN \u0026gt;30 mg/dL.\u003c/p\u003e\n\u003cp\u003eThe mean INR was 1.30, with values ranging from 0.85 to 5.00. Approximately 86.4% had an INR \u0026lt;1.5, whereas 13.6% had an elevated INR. The mean PT was 13.42 seconds, with a wide range from 1 to 32 seconds. A total of 43.2% of patients had PTs \u0026gt;13 seconds. The aPTT ranged from 13.9 to 377 seconds, with a mean of 34.09 seconds. Approximately 21% had elevated aPTT (\u0026gt;35 s). The mean potassium concentration was 5.88 mmol/L. A total of 35.8% were hypokalemic (\u0026lt;3.5), 57.7% were normal (3.5\u0026ndash;5) and 5.1% were hyperkalemic (\u0026gt;5). The mean sodium concentration was 134.6 \u0026plusmn; 15.82 mmol/L. Nearly all the values fell within the normal range (135\u0026ndash;145). The mean chloride level was 101.5, ranging from 85 to 115 mmol/L. A total of 70.1% had normal values (95\u0026ndash;105 mmol/L), 5.2% were hyperchloremic (\u0026lt;95 mmol/L), and 24.7% were hyperchloremic. (\u0026gt;105 mmol/L). Among the 81 patients, only 4.9% had a culture test performed. Among these samples, the only sample type recorded was blood culture. For microorganism identification, \u003cem\u003eEscherichia coli\u003c/em\u003e was isolated from 1 patient (1.2%) (Table 5).\u003c/p\u003e\n\u003cp\u003eTable 5: Cultures and microorganisms, Addis Ababa, 2025\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003efrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eCulture performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e95.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eTypes of culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eBlood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eIsolated microorganism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003eNot documented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eImaging modalities\u003c/h2\u003e\n\u003cp\u003eThe imaging modalities used were abdominal ultrasound (US), computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP). Abdominal ultrasound was used as the initial\u0026nbsp;imaging modality in all the\u0026nbsp;patients. Approximately\u0026nbsp;81.5% of\u0026nbsp;the\u0026nbsp;cases were further investigated\u0026nbsp;via\u0026nbsp;either CT\u0026nbsp;scan or MRCP.\u0026nbsp;Approximately\u0026nbsp;15% of patients had only biliary dilation as evidence of obstruction,\u0026nbsp;while the\u0026nbsp;etiologies of the remaining patients were\u0026nbsp;identified preoperatively.\u0026nbsp;The majority\u0026nbsp;of the\u0026nbsp;latter were\u0026nbsp;those who had only abdominal US as the sole imaging modality.\u003c/p\u003e\n\u003ch2\u003eSeverity and Diagnosis According to the TG13 Criteria\u003c/h2\u003e\n\u003cp\u003eAll patients had a recorded diagnosis of acute cholangitis. When TG13 was applied retrospectively, 70.4% of patients were reclassified as definite acute cholangitis, 17.3% as suspected cholangitis, and 12.3% as noncholangitis. Severity grading revealed that 50.6% were classified as Grade I (mild), whereas 25.9% and 6.2% were Grade II and III, respectively. The severity of disease in 17.3% of the patients was not recorded. Approximately 69.1%, 23.5%, and 7.4% were reclassified as Grade I, Grade II, and Grade III, respectively. The positive predictive value (PPV) of the recorded diagnosis compared with that of TG13 was 85.1%. Severity grading via TG13 also revealed differences from the recorded assessments. The PPV for Grade I disease was 95.1%, the PPV for Grade II disease was 66.7%, and the PPV for Grade III disease was 80.0% (Table 6).\u003c/p\u003e\n\u003cp\u003eTable 6: Retrospective severity grading according to TG13\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003eRetrospective severity grading\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eI(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eII(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eIII(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecorded severity grade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eGrade I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e39(95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eGrade II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e6(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e14(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eGrade III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eNot recorded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e11(78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e3(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 411px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetrospective diagnosis according TG13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eDefinitive AC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e32(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e19(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e6(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eNoncholangitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e10(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eSuspected AC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e10(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eManagement of Acute Cholangitis\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eInitial Management and Response\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most common initial interventions included fluid resuscitation, antibiotics, and pain management (70.4%). All patients received ceftriaxone and metronidazole. The majority (85.2%) improved with initial therapy (Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Initial Management of patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFluid, antibiotics, pain management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFluid, antibiotics, pain, nutritional support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFluid + antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmergency Interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwelve patients received emergency interventions. Additionally, 84.0% of patients required further definitive surgical management. Six patients received emergency surgical \u0026nbsp;interventions: four patients underwent ERCP, and 2 patients underwent percutaneous transhepatic cholangiography (PTC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitive and palliative management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 81 patients, 72 (88.9%) required either definitive or palliative intervention. The most common procedures were cholecystectomy with CBDE, triple bypass, Whipple\u0026rsquo;s procedure and hepaticojejunostomy (Table 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8. Types of definitive management of patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Definitive Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCholecystectomy + CBDE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBiliary-enteric bypass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWhipple\u0026rsquo;s procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCholecystectomy alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHepaticojejunostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers (Gastrojejunostomy, Shunt, PTC etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes, Complications, and Length of Stay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately 60% of patients had favorable outcomes. The remaining 40% either developed complications or had prolonged hospital stays (which were \u0026gt;= 23 days in our study), as shown in Figure 2. Overall, 19.8% of patients developed complications. These included liver abscess, intensive care unit (ICU) admission, persistent organ failure, hospital mortality, and 30-day mortality (Table 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9. Management outcomes of patients with acute cholangitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003eManagement outcomes of the patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; Developed complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; Improved and discharged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e80.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003eThe list of complication (n=16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; 30-day Mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; ICU admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; ICU admission, Persistent Organ Failure, In hospital Mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; In hospital Mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; liver abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e41.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; Persistent Organ Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003eDuration of hospital stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; \u0026lt;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e76.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u0026middot; \u0026ge;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e23.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFactors\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eassociated\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;with\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eadverse outcomes of acute cholangitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBivariate logistic regression analyses were conducted to explore the relationships between various demographic and clinical variables and adverse outcomes in patients with acute cholangitis. Initially, bivariate logistic regression was run, and a cutoff of 0.2 was used to screen for variables potentially associated with adverse outcomes of acute cholangitis. Variables that were eligible for inclusion were further entered into the multivariable logistic regression.\u003c/p\u003e\n\u003cp\u003eIn this study, age, loss of appetite, weight loss, comorbidities and retrospective grading were significantly associated with the outcome of AC according to bivariate binary logistic regression. Multivariate logistic regression analysis revealed that individuals over 60 years of age had a fourfold increased risk of experiencing an unfavorable outcome of AC compared with those aged 21\u0026ndash;40 years (AOR = 4.0, 95% CI: 1.89\u0026ndash;18.00). Similarly, those who reported weight loss had 4.3 times greater odds of an unfavorable outcome than those without weight loss (AOR = 4.3, 95% CI: 1.94\u0026ndash;19.40). Furthermore, individuals with comorbidities were 3.4 times more likely to have an unfavorable outcome than those without comorbid conditions were (AOR = 3.4, 95% CI: 1.55\u0026ndash;21.03).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"678\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eOutcome of acute cholangitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eCOR with 95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAOR with 95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eunfavorable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003efavorable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e21-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e41-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.9(0.53, 6.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.92(0.20, 4.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026gt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e4.8(1.39, 16.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.0(1.89, 18.00)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003erural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e2.3(0.92, 5.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.4(0.37, 5.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eDark urine color\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e2.4(0.94, 6.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.8(0.46, 7.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eLoss of appetite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e4.4(1.64, 11.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2.2(0.59, 8.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eWeight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e5.7(2.00, 16.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.040\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.3(1.94, 19.40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e2.9(1.09, 8.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.4(1.55, 21.03)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e3.1(0.79, 12.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2.6(0.43, 15.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e2.5-2.5-3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.4(0.49, 3.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.1(0.29, 3.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026gt;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eRetrospective severity grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eGrade I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eGrade II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e2.9(1.12, 7.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.85(0.151, 4.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eGrade III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn our study, we described the clinical profile, investigations and management of patients who had acute cholangitis for more than five years. Our participants had an average age of 53.96 years, with 56.8% females, which contrasts with many reports of acute cholangitis affecting older, male-predominant populations. For example, Kiriyama et al. reported a mean age of 72.2 years and a 59% male predominance in their multicenter study(40). A South Indian study similarly reported a male majority with a mean age of 51.7 years(6). However, in Indonesia, a slight female predominance of 51.6% (39)\u0026nbsp;was reported, which was consistent with our findings. These findings could be attributed to the general predisposition of females to choledocholithiasis, which can also be found in old individuals, as diabetes is commonly found in old individuals and has been shown to increase the likelihood of acute cholangitis.\u003c/p\u003e\n\u003cp\u003eCholedocholithiasis was the most common cause of cholangitis in our study (50.6%), which is in line with the literature, where bile duct stones account for 54% to over 60% of cases (4,6,39,40). Malignancy accounted for 40.7% of our cases, which is higher than in previous reports, such as Kiriyama's 15.6%\u0026nbsp;(40)\u0026nbsp;and Raghhupatruni's 17.1%\u0026nbsp;(6). This discrepancy may reflect our hospital's tertiary referral status, with a greater burden of malignant obstructions. Jaundice (95.1%) and right upper quadrant pain (71.6%) were the most common presenting symptoms in our patients, in parallel with findings in previous studies that emphasized cholestasis and biliary obstruction as central to acute cholangitis presentation\u0026nbsp;(8,36,37). Only 30.9% of our patients had fever, and the full Charcot triad was observed in only 18.5% of our patients, reinforcing its low sensitivity despite its high specificity\u0026nbsp;(14,36). Kiriyama et al. also reported a similar diagnostic rate for Charcot's triad, with positivity in only 21.2% of the study participants included(40). This finding shows that decisions in the diagnosis of acute cholangitis cannot be based only on clinical manifestations.\u003c/p\u003e\n\u003cp\u003eFor our study participants, total bilirubin was \u0026gt;10 mg/dL in nearly half of the patients, with ALP ≥4-fold elevated in 45.7% and AST similarly increased. Coagulopathy was evident in 46.9% of the patients, with PTs \u0026gt;13 seconds. These findings are similar to those of prior studies identifying bilirubin, hypoalbuminemia, and the international normalized ratio (INR) as severity indicators(6, 40). Microbiological testing was severely limited; only 4.9% of cultures were performed. Studies on similar topics have shown that blood cultures are positive in 15.7% to 40% of cases and that bile cultures are positive in up to 83% of cases\u0026nbsp;(8, 38). \u003cem\u003eE. coli\u003c/em\u003e was isolated from our single culture-positive patient, which is consistent with global reports that listed \u003cem\u003eE. coli\u003c/em\u003e and Klebsiella as the predominant pathogens\u0026nbsp;(8, 38). The limited availability of culture results in our study could have impacted its representativeness.\u003c/p\u003e\n\u003cp\u003eOur study revealed that all 81 patients were initially diagnosed with definite AC, but only 70.4% met the Tokyo Guidelines 2013 (TG13) criteria retrospectively. This overdiagnosis was also reported by Soares et al., who reported an initial recorded prevalence of 9.9%, which increased to 43% when the TG13 criteria were retrospectively applied\u0026nbsp;(7). Similarly, Kiriyama et al. reported that 73.1% of cases fulfilled definite acute cholangitis criteria, whereas 16.9% were classified as suspected\u0026nbsp;(40). This could be due to a high index of suspicion by the surgeon in order not to miss any patient who has the potential to be diagnosed with acute cholangitis.\u003c/p\u003e\n\u003cp\u003eWith respect to management,initial management with intravenous fluids, antibiotics (ceftriaxone and metronidazole), and pain control was administered to all patients, which is consistent with TG13 recommendations that prioritize early stabilization(13). In our study, 85.2% of the patients responded to medical therapy alone, which is consistent with the 70% rate reported in the literature(44). Only 14.8% of the patients required emergency intervention (ERCP, surgical drainage, or PTC). Surgical intervention was the most common definitive treatment, with cholecystectomy and common bile duct exploration performed in 35.8% of patients. This finding does not align with the literature, where ERCP was the predominant intervention in 79.1% of cases\u0026nbsp;(45). The reliance on surgery may be due to the limited availability of endoscopic services in our setup.\u003c/p\u003e\n\u003cp\u003eAge was significantly associated with both severity and adverse outcomes, supporting earlier studies that identified advanced age as a poor prognostic factor\u0026nbsp;(40). Hypoalbuminemia, elevated PT, increased BUN, and tachycardia were also correlated with poor outcomes in our study. These findings are in line with previous work by Raghhupatruni et al. and Kiriyama et al., who linked an albumin concentration \u0026lt;2.8 g/dL, an international normalized ratio (INR) \u0026gt;1.2, and a CRP concentration \u0026gt;85.5 mg/L with severe acute cholangitis\u0026nbsp;(6, 40). The multivariate analysis in our study revealed that weight loss, comorbidities, and loss of appetite were significantly associated with adverse outcomes, likely reflecting systemic illness and delayed presentation. Similarly, increased pulse rates and low albumin levels were associated with higher TG13 severity scores, confirming their use as bedside prognostic markers.\u003c/p\u003e\n\u003cp\u003eThis study emphasizes the need for the routine use of the TG13 criteria to ensure diagnostic accuracy. The inadequate use of microbiological testing and reliance on surgical rather than endoscopic management indicate areas for improvement. Early identification of patients at risk for severe disease via simple clinical and laboratory parameters can guide timely intervention, even in low-resource settings.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eAcute cholangitis remains a common condition that can be treated with multiple management options. Our study revealed variables associated with acute cholangitis that could help us improve diagnosis. While the outcomes were generally favorable in this study, there is still room for improvement in terms of diagnostic accuracy, microbiological assessment, and early risk stratification. The adoption of guideline-based practices, especially the TG13 criteria, should be implemented to improve patient care.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"RECOMMENDATIONS","content":"\u003cp\u003eIn this study, we elucidated the factors that influence acute cholangitis, which provides insight into the best ways to diagnose acute cholangitis and the factors to consider. To improve outcomes in patients with acute cholangitis, we recommend the routine use of the Tokyo Guidelines for diagnosis, severity grading, and treatment planning. Expanding local capacity for endoscopic services and enhancing coordination across referring facilities would ensure prompt and appropriate management. Finally, we would like to call all stakeholders to use resources for the early diagnosis of acute cholangitis at different levels of the health system.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was based on data from one hospital, which limits its generalizability. Retrospective data can be affected by gaps in record keeping and documentation. Furthermore, the retrospective study design limits inference on the cause‒effect relationship.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Acute cholangitis\u003c/p\u003e\n\u003cp\u003eALT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Alanine aminotransferase\u003c/p\u003e\n\u003cp\u003eAST\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Aspartate aminotransferase\u003c/p\u003e\n\u003cp\u003eALP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Alkaline phosphatase\u003c/p\u003e\n\u003cp\u003eCBD\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Common bile duct\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confidence interval\u003c/p\u003e\n\u003cp\u003eCT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Computed Tomography\u003c/p\u003e\n\u003cp\u003eDB\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Direct bilirubin\u003c/p\u003e\n\u003cp\u003eERCP\u0026nbsp; \u0026nbsp;\u0026nbsp;Endoscopic retrograde cholangiopancreatography\u003c/p\u003e\n\u003cp\u003eGI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Gastrointestinal\u003c/p\u003e\n\u003cp\u003eICU\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eIQR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Interquartile range\u003c/p\u003e\n\u003cp\u003eLFT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Liver function test\u003c/p\u003e\n\u003cp\u003eMRCP\u0026nbsp; \u0026nbsp;Magnetic Resonance Cholangiopancreatography\u003c/p\u003e\n\u003cp\u003eOPD\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Outpatient Department\u003c/p\u003e\n\u003cp\u003eOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Odds ratio\u003c/p\u003e\n\u003cp\u003ePT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Prothrombin time\u003c/p\u003e\n\u003cp\u003ePTC \u0026nbsp; \u0026nbsp; \u0026nbsp;Percutaneous transhepatic cholangiography\u003c/p\u003e\n\u003cp\u003eRUQ\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Right Upper Quadrant\u003c/p\u003e\n\u003cp\u003eSD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standard deviation\u003c/p\u003e\n\u003cp\u003eSPSS\u0026nbsp; \u0026nbsp; \u0026nbsp;Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003eTB\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Total bilirubin\u003c/p\u003e\n\u003cp\u003eTG13\u0026nbsp; \u0026nbsp;\u0026nbsp;Tokyo Guidelines 2013\u003c/p\u003e\n\u003cp\u003eTG18\u0026nbsp; \u0026nbsp;\u0026nbsp;Tokyo Guidelines 2018\u003c/p\u003e\n\u003cp\u003eUS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ultrasound\u003c/p\u003e\n\u003cp\u003eWBC \u0026nbsp; \u0026nbsp; White blood cell (WBC) count\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used in this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved human participants through the use of secondary data obtained from medical records. Ethical approval was obtained from the Ethical Review Committee of the Department of Surgery, Tikur Anbessa Specialized Hospital, and a waiver of informed consent was granted as described above.\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\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has not received any form of funding, and expenses were covered by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGE wrote the proposal, ST collected the data and AM analyzed the data. AM and GE wrote the final manuscript. ZA reviewed and provided directions during the write-up process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Generative AI and AI-assisted technologies in the writing process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the preparation of this work, the author used Curie to improve the language. After using this tool/service, the author reviewed and edited the content as needed and takes full responsibility for the content of the published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe views and opinions expressed in this article are those of the author/authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or publisher. The authors are responsible for this article\u0026apos;s results, findings, and content.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLipsett PAPH. Acute cholangitis. Surg Clin North Am. 1999;70:1297\u0026ndash;312.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKimura YTT, Kawarada Y, et al. Definitions, patho-physiology, and epidemiology of acute cholangitis andcholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:15\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSung JYCJ, Shaffer EA. Defense system in the biliary tract against bacterial infection. Dig Dis Sci 1992:689\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGomi H, Takada T, Hwang TL, Akazawa K, Mori R, Endo I, et al. Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis. 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Microbiology and clinical characteristics of acute cholangitis with their impact on mortality; a retrospective cross sectional study, 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiriyama SKK, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;25(1):17\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiura FTT, Strasberg SM, Solomkin JS, Pitt HA, Gouma DJ, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:47\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAboelsoud M, Siddique O, Morales A, Seol Y, Al-Qadi M. Early biliary drainage is associated with favorable outcomes in critically ill patients with acute cholangitis. Prz Gastroenterol. 2018;13(1):16\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaresh Agarwal BCS SKS. 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Br J Surg. 1992;79:655\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiham A, Affan AWN, Marcelo AF, Ribeiro Jr. Classification and Management of Acute Cholangitis. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCozma MA, Gaman MA, Srichawla BS, Dhali A, Manan MR, Nahian A, et al. Acute cholangitis: a state-of-the-art review. Ann Med Surg (Lond). 2024;86(8):4560\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliam R, Jarnagin M, BLUMGART\u0026rsquo;S SURGERY FACS. OF THE LIVER, BILIARY TRACT, AND PANCREAS,2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrasanth Raghhupatruni Rajesh Gopalakrishna VAaSS. Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India. J Digest Endosc. 2021;12:127\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBudianto A. THE RELATIONSHIP BETWEEN SEVERITY OF ACUTE CHOLANGITIS WITH MORTALITY LEVE. 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiriyama S, Takada T, Hwang TL, Akazawa K, Miura F, Gomi H, et al. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. J Hepatobiliary Pancreat Sci. 2017;24(6):329\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiriyama STT, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012;19:548\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSARAH, P\u0026Ouml;TTER- LANG AB-S. 1NINA BASTATI, 1ALINA MESSNER, 1ANTONIA KRISTIC, 1RAPHAEL AMBROS, 1ALEXANDER HEROLD, 1JACQUELINE C. HODGE and 2MICHAEL TRAUNER. Modern imaging ofcholangitis. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalas MK 1, KS IG. Errors and mistakes in the ultrasound diagnostics of the liver, gallbladder and bile ducts. 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eal VLAe. Duration of antibiotic therapy forcholangitis after successful endoscopic drainage of the biliary tract. Gastrointest Endosc. 2002;55:518\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTagashira Y, Sakamoto N, Isogai T, Hikone M, Kosaka A, Chino R, et al. Impact of inadequate initial antimicrobial therapy on mortality in patients with bacteraemic cholangitis: a retrospective cohort study. Clin Microbiol Infect. 2017;23(10):740\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaresh Agarwal BCS, Shiv K, Sarin. Endoscopic management of acute cholangitis in elderly patients. World J Gastroenterol. 2006;12(40):6551\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acute cholangitis, clinical profile, Ethiopia, management","lastPublishedDoi":"10.21203/rs.3.rs-8412335/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8412335/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAcute cholangitis is an acute inflammation and infection within the biliary tree that is usually secondary to mechanical obstruction, such as choledocholithiasis, malignant biliary obstruction, benign strictures, ampullary or duodenal obstruction, and stent blockade or dysfunction of the sphincter of Oddi. Accurate and up-to-date epidemiological data concerning acute cholangitis are relatively scarce, especially in sub-Saharan African countries. This study on the clinical profile and management of acute cholangitis holds significant importance for both clinical practice and public health by characterizing the clinical presentation and demographic features of patients with acute cholangitis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study was conducted at Tikur Anbessa Specialized Hospital, the largest healthcare facility in Ethiopia, which is located in Addis Ababa. The study covered a five-year period, from January 2020 to December 2024. A hospital-based retrospective study was conducted. Data were obtained from the medical records of patients (charts) diagnosed with cholangitis. Bivariable and multivariable logistic regression were used, and statistical significance was set at a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 to compare independent variables with outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe medical records of 81 patients with a diagnosis of acute cholangitis fulfilling the inclusion criteria were included in the study. The mean age of the patients was 53.96 years, and 56.8% were female. The most common etiology was choledocholithiasis (50.6%). Jaundice (95.1%) and RUQ-related abdominal pain (71.6%) were the most common presenting symptoms. Medical management alone was successful in 85.2% of the patients. Adverse outcomes, including liver abscess, intensive care unit (ICU) admission, and two deaths (2.5%), occurred in 21% of patients. Multivariate analysis revealed that age, weight loss, pulse rate, platelet count, albumin level, and prothrombin time were predictors of poor outcomes. The serum ALB concentration and PT were also associated with higher severity scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAcute cholangitis in this setting is primarily due to choledocholithiasis and presents late. Outcomes are generally favorable, but gaps exist in microbiologic testing and early intervention. The incorporation of the TG13 criteria for diagnosis and grading, improved access to endoscopic therapy, and early risk stratification via clinical and laboratory markers are essential for optimizing care.\u003c/p\u003e","manuscriptTitle":"Clinical Profile, Management and Outcomes of Acute Cholangitis: 5 Years Experience at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 11:48:57","doi":"10.21203/rs.3.rs-8412335/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-08T20:06:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222713802519215537843238012641517289977","date":"2026-01-29T13:36:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187672588667772688253731593387137340416","date":"2026-01-29T13:17:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78208768000271203589974825735942277787","date":"2026-01-20T14:09:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-20T13:26:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-30T15:27:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T04:55:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T04:54:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-12-20T12:59:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2f289742-3e25-49ea-8ac7-06bb32e4b807","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T11:48:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 11:48:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8412335","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8412335","identity":"rs-8412335","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}