S44 Investigation of Clinical Outcomes in Patients With Primary Sclerosing Cholangitis With Acute Cholecystitis

Introduction: Primary sclerosing cholangitis (PSC) is a chronic idiopathic cholestatic hepatobiliary disease. It is characterized by diffuse fibrotic inflammation of the intrahepatic and/or extrahepatic bile duct with concomitant bile duct strictures and dilatations. PSC is associated with gallbladder disease with 25% of patients developing acute cholecystitis (AC). In the United States, AC annual health care cost is approximately $6.5 billion with a mortality rate of 0.6% overall and 6% in severe cases. Interestingly, despite the high rate of AC in PSC, there are limited studies assessing clinical outcomes in this patient population. This study aims to investigate the impact of PSC on the clinical outcomes in AC patients. Methods: We conducted a population-based, nationwide retrospective cohort study for the time period of June 1, 2000, to December 31, 2023, using the TriNetX platform. Adult patients ≥18 years old with AC were included. The intervention cohort were patients with AC and PSC, while the control cohorts were patients with AC without PSC. Patients were matched using a 1:1 propensity score match (PSM) according to demographics and bariatric procedures. Results: After PSM, the intervention and control cohort equaled 507 patients. Given that all PSM assumptions hold, AC patients with PSC had a significantly higher rate of mortality (RR 2.67; 95% CI 1.77, 3.18), severe sepsis (RR 2.34; 95% CI 1.68, 3.26), and peritonitis (RR 2.44; 95% CI 1.58, 3.76). Interestingly, there was a lower rate of gallbladder complications (gallbladder gangrene and perforation) (RR 0.37; 95% CI 0.18, 0.76). Conclusion: Our study highlights that primary sclerosing cholangitis patients with acute cholecystitis experienced significant worse clinical outcomes including mortality, severe sepsis and peritonitis but not gallbladder complication. These findings emphasize the need for a heightened level of care in this patient population to improve clinical outcomes.