S119 Navigating Acute Cholangitis in Cirrhosis: A Retrospective Analysis of Outcomes and Procedural Choices

Introduction: Acute cholangitis (AC) is a life-threatening biliary infection resulting from bile stasis and bacterial overgrowth. Cirrhosis, on the other hand, is a progressive liver condition characterized by fibrosis and regenerative nodules, often leading to liver failure. The coexistence of AC and cirrhosis, with reduced capacity to mitigate inflammatory insults, likely results in worse prognosis. However, limited evidence exists regarding this relationship, and no guidelines address AC management in cirrhotic patients. This study aims to examine the relationship between cirrhosis and clinical outcomes in AC patients. Methods: Our study involved a retrospective cohort analysis using the Nationwide Readmission Database for the years 2016 to 2020. We included adult patients (aged ≥18 years) admitted with a principal diagnosis of AC and had either undergone endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous biliary drainage (PBD), utilizing the International Classification of Diseases, Tenth Revision, and Clinical Modifications (ICD-10-CM) codes. Analyses was performed using STATA, version 14.2. Results: We included 48,466 AC patients of whom 1,990 (4.11%) patients had cirrhosis. Cirrhotic patients were younger and predominantly men. In-hospital mortality of AC was significantly higher in patients with cirrhosis when compared to those without cirrhosis (adjusted odds ratio (aOR) 3.37, P < 0.01). Furthermore, patients with cirrhosis had higher odds for septic shock, acute renal failure, and need for admission to the intensive care unit. Thus, patients with cirrhosis had higher odds of severe AC (aOR 1.81, P < 0.01). From a procedural viewpoint, cirrhotic patients had higher odds of undergoing PBD but lower odds of undergoing “early” ERCP (ERCP within 24 hours of admission). We also found that cirrhotic patients, when compared to their non-cirrhotic counterparts, were more likely to undergo PBD as opposed to early ERCP (aOR 1.44, P = 0.02). Finally, the rate of same-admission cholecystectomy was also lower in patients with cirrhosis (aOR 0.44, P < 0.01). Conclusion: Cirrhosis profoundly affects the clinical trajectory and management of AC, resulting in poorer patient outcomes and a preference for PBD over early ERCP. These findings highlight the critical need for heightened clinical vigilance and tailored therapeutic approaches for this vulnerable population.