Cholangitis-associated septic shock carries significant mortality.
There is uncertainty regarding the most appropriate time to achieve biliary decompression.
Dr Karvellas and colleagues from Canada determined whether the timing of biliary decompression and anti-microbial therapy affect the survival in cholangitis patients with septic shock.
The team performed a nested retrospective cohort study of all cholangitis-associated septic shock patients from an international, multi-center database between 1996 and 2011.
|Overall mortality was 37%|
|Alimentary Pharmacology & Therapeutics|
Among 260 patients, the researchers found that overall mortality was 37%.
Compared to nonsurvivors, the team noted that survivors had lower mean admission Acute Physiology And Chronic Health Evaluation (APACHE) II, and lower median serum lactate on admission.
The team observed that survivors were more likely to receive appropriate anti-microbial therapy earlier.
Survivors were also more likely to undergo successful biliary decompression earlier.
After adjusting for co-variates, the team found that APACHE II, time delay to appropriate anti-microbial therapy, and delayed biliary decompression of more than 12 hours were all significantly associated with increased mortality.
Dr Karvellas's team comments, "Patients with septic shock secondary to acute cholangitis have significant mortality."
"Endoscopic biliary decompression more than 12 hours after the onset of shock and delayed receipt of appropriate anti-microbial therapy were both significantly associated with adverse hospital outcome."
"This might suggest that early initiation of anti-microbial therapy and urgent biliary decompression could potentially improve outcomes in this high-risk patient population."