Risk Factors for Systemic Inflammatory Response Syndrome After Percutaneous Transhepatic Cholangioscopic Lithotripsy

Overview

Journal J Inflamm Res

Publisher Dove Medical Press

Date 2024 Apr 30

PMID 38686361

Authors

Lve Cheng

Junwei Niu

Yao Cheng

Jie Liu

Mengjia Shi

Shijia Huang

Xiong Ding

Shengwei Li

Affiliations

Soon will be listed here.

Abstract

Background: There is a lack of validated predictive models for the occurrence of systemic inflammatory response syndrome (SIRS) after percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for the treatment of hepatolithiasis. This is the first study to estimate the incidence of SIRS after PTCSL.

Methods: A retrospective analysis of 284 PTCSL sessions for the treatment of hepatolithiasis at our institution between January 2019 and January 2023 was performed. The development of SIRS after PTCSL was the primary study endpoint. Independent risk factors for SIRS after PTCSL were identified using univariate and multivariate logistic regression analyses. A nomogram prediction model was constructed using these independent risk factors, and the predictive value was assessed using receiver operating characteristic (ROC) curves.

Results: The incidence of SIRS after PTCSL was 20.77%. According to multivariate analysis, the number of PTCSL sessions (odds ratio [OR]=0.399, 95% confidence interval [CI]=0.202-0.786, p=0.008), stone location (OR=2.194, 95% CI=1.107-4.347, p=0.024), intraoperative use of norepinephrine (OR=0.301, 95% CI=0.131-0.689, p=0.004), intraoperative puncture (OR=3.476, 95% CI=1.749-6.906, P<0.001), preoperative gamma-glutamyltransferase (OR=1.002, 95% CI=1.001-1.004, p=0.009), and preoperative total lymphocyte count (OR=1.820, 95% CI=1.110-2.985, p=0.018) were found to be independent risk factors for the development of SIRS after PTCSL. These six independent risk factors were used to construct a nomogram prediction model, which showed satisfactory accuracy with an area under the ROC curve of 0.776 (95% CI: 0.702-0.850).

Conclusion: The number of PTCSL sessions, stone location, intraoperative use of norepinephrine, intraoperative puncture, preoperative gamma-glutamyltransferase, and preoperative total lymphocyte count may predict the occurrence of SIRS after PTCSL. This prediction model may help clinicians identify high-risk patients in advance.

References

Peng L, Xiao J, Liu Z, Zhu J, Wan R, Xiao W . Laparoscopic left-sided hepatectomy for the treatment of hepatolithiasis: A comparative study with open approach. Int J Surg. 2017; 40:117-123. DOI: 10.1016/j.ijsu.2017.02.068. View

Kim H, Kim J, Joo M, Lee B, Kim J, Yeon J . Hepatolithiasis and intrahepatic cholangiocarcinoma: A review. World J Gastroenterol. 2016; 21(48):13418-31. PMC: 4690170. DOI: 10.3748/wjg.v21.i48.13418. View

Chen M, Jan Y . Percutaneous transhepatic cholangioscopic lithotripsy. Br J Surg. 1990; 77(5):530-2. DOI: 10.1002/bjs.1800770519. View

Tao H, Wang P, Sun B, Li K, Zhu C . One-Step Multichannel Percutaneous Transhepatic Cholangioscopic Lithotripsy Applied in Bilateral Hepatolithiasis. World J Surg. 2020; 44(5):1586-1594. DOI: 10.1007/s00268-020-05368-7. View

Qiu X, Lei Y, Zhou R . SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2023; 21(8):891-900. DOI: 10.1080/14787210.2023.2237192. View

Song J, Sin C, Park H, Shim S, Lee J . Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis. Crit Care. 2018; 22(1):28. PMC: 5802050. DOI: 10.1186/s13054-018-1952-x. View

Askim A, Moser F, Gustad L, Stene H, Gundersen M, Asvold B . Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department. Scand J Trauma Resusc Emerg Med. 2017; 25(1):56. PMC: 5466747. DOI: 10.1186/s13049-017-0399-4. View

Serafim R, Gomes J, Salluh J, Povoa P . A Comparison of the Quick-SOFA and Systemic Inflammatory Response Syndrome Criteria for the Diagnosis of Sepsis and Prediction of Mortality: A Systematic Review and Meta-Analysis. Chest. 2018; 153(3):646-655. DOI: 10.1016/j.chest.2017.12.015. View

Mukai S, Itoi T, Baron T, Takada T, Strasberg S, Pitt H . Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci. 2017; 24(10):537-549. DOI: 10.1002/jhbp.496. View

10.

Huang L, Lai J, Liao C, Wang D, Wang Y, Tian Y . Classification of left-side hepatolithiasis for laparoscopic middle hepatic vein-guided anatomical hemihepatectomy combined with transhepatic duct lithotomy. Surg Endosc. 2023; 37(7):5737-5751. DOI: 10.1007/s00464-023-10198-4. View

11.

Artis D, Spits H . The biology of innate lymphoid cells. Nature. 2015; 517(7534):293-301. DOI: 10.1038/nature14189. View

12.

Seymour C, Liu V, Iwashyna T, Brunkhorst F, Rea T, Scherag A . Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):762-74. PMC: 5433435. DOI: 10.1001/jama.2016.0288. View

13.

Hwang M, Mo L, Yang J, Lin C . Percutaneous transhepatic cholangioscopic ultrasonic lithotripsy (PTCS-USL) in the treatment of retained or recurrent intrahepatic stones. Gastrointest Endosc. 1987; 33(4):303-6. DOI: 10.1016/s0016-5107(87)71604-6. View

14.

Huang M, Chen C, Yang J, Yang C, Yeh Y, Chou D . Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis. Am J Gastroenterol. 2003; 98(12):2655-62. DOI: 10.1111/j.1572-0241.2003.08770.x. View

15.

Miura F, Okamoto K, Takada T, Strasberg S, Asbun H, Pitt H . Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2017; 25(1):31-40. DOI: 10.1002/jhbp.509. View

16.

Lau W, Fan S, Yip W, Poon G, Wong K . Optimal irrigation pressures in operative choledochoscopy. Aust N Z J Surg. 1988; 58(1):63-6. DOI: 10.1111/j.1445-2197.1988.tb00970.x. View

17.

Yin Z, Shen B . Comparative study of the effect of U100 laser and pneumatic ballistic combined with percutaneous transhepatic cholangioscopic lithotomy in the treatment of intra-and extrahepatic bile duct stones and its effect on liver function. Pak J Med Sci. 2022; 38(6):1686-1690. PMC: 9378421. DOI: 10.12669/pjms.38.6.5903. View

18.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

19.

Clere-Jehl R, Mariotte A, Meziani F, Bahram S, Georgel P, Helms J . JAK-STAT Targeting Offers Novel Therapeutic Opportunities in Sepsis. Trends Mol Med. 2020; 26(11):987-1002. DOI: 10.1016/j.molmed.2020.06.007. View

20.

Peng J, Wang L, Diao J, Tan Z, Zhong X, Zhen Z . Major hepatectomy for primary hepatolithiasis: a comparative study of laparoscopic versus open treatment. Surg Endosc. 2018; 32(10):4271-4276. PMC: 6132873. DOI: 10.1007/s00464-018-6176-2. View