A327 OPTIMAL TIMING OF BILIARY DRAINAGE IN SEVERE ASCENDING CHOLANGITIS
Notice bibliographique
Résumé
Optimal timing of biliary drainage in ascending cholangitis (AC) is unclear. Early drainage is recommended in moderate and severe AC cases. However, demonstrable benefit in mortality and morbidity outcomes based on timing of biliary drainage is lacking. To investigate if the time to biliary drainage provides benefit in mortality and morbidity outcomes in severe AC. We completed an updated retrospective database analysis and chart review of ICU admitted AC cases between 2000 and 2014. This was completed using the University of Manitoba Adult ICU Database and manual chart review of flagged ICU admitted cholangitis cases in order to verify the diagnosis and assess clinical outcomes. Statistical analysis has included creation of linear and logistic regression models and survival analysis for mortality and length of stay. In total, 198 cases were flagged in the database. After chart review, 114 cases of AC were identified in 113 patients. The population mean age was 72 (SD 13.5), gender was 44% female, and mean APACHE II score was 22.3 (SD 8.0). The majority of cases (79%) were managed predominantly in tertiary care hospitals compared with community ICUs (21%). The mean time to biliary drainage was 49 hours (SD 56.0) and 16 cases did not undergo biliary drainage (14 of whom died). Mean length of hospital stay was 32.7 days (SD 76.7). In unadjusted logistic regression, biliary drainage was associated with significantly reduced odds of mortality (OR 0.11, p = 0.007, 95% CI 0.02 – 0.55). Logistic regression of time to biliary drainage, when controlling for APACHE score, did not appear to be associated with death (OR 1.0, p = 0.82). Survival analysis predicting length of stay in hospital by time to biliary drainage, though not statistically significant, suggested a possibly reduced hazard rate for those groups that were drained between 15–69 hours (HR .56, p = 0.24) and 70+ hours (.49, p = .24) compared with those drained in less than 15 hours. In severe AC, biliary drainage may be associated with reduced mortality; however, time to biliary drainage in this analysis has not demonstrated to be associated with altered mortality. Early biliary drainage showed a non-significant trend toward shorter hospital length of stay. Rigorous competing risks analysis is ongoing to assess for confounders and to investigate the associations between these and other health related outcomes. None
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».