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Inicio Gastroenterología y Hepatología (English Edition) Predictive model of persistent choledocholithiasis in patients with acute biliar...
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Vol. 46. Issue 4.
Pages 297-304 (April 2023)
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Vol. 46. Issue 4.
Pages 297-304 (April 2023)
Original article
Predictive model of persistent choledocholithiasis in patients with acute biliary pancreatitis
Modelo predictivo de coledocolitiasis persistente en pacientes con pancreatitis aguda biliar
Alejandro Míngueza, Pablo Ladróna, Sara Martíneza, Adolfo Del Vala, Pilar Nosa,b, Enrique de-Madariac,d,
Corresponding author
emadaria@umh.es

Corresponding author.
a Gastroenterology Department, Digestive Medicine Service, La Fe University and Polytechnic Hospital, Valencia, Spain
b Networked Biomedical Research Center for Hepatic and Digestive Diseases (CIBEREHD), Institute of Health Carlos III, 28029 Madrid, Spain
c Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
d Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Spain
Article information
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Table 1. Baseline characteristics of patients without and with PC.
Table 2. Multiple logistic regression model for predicting persistent choledocholithiasis in patients with acute biliary pancreatitis.
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Abstract
Background

Choledocholithiasis causing acute biliary pancreatitis (ABP) may migrate to the duodenum or persist in the common bile duct (CBD). We developed a model for predicting persistent choledocholithiasis (PC) in patients with ABP.

Methods

This retrospective cohort study included 204 patients, age ≥18 years (mean age: 73 years, 65.7% women), admitted for ABP in 2013–2018, with at least a magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and/or endoscopic retrograde cholangiopancreatography (ERCP). Epidemiological, analytical, imaging, and endoscopic variables were compared between patients with and without PC. Multivariate logistic regression analyses were performed to develop a predictive model of PC.

Results

Patients underwent MRCP (n=145, 71.1), MRCP and ERCP (n=44, 21.56%), EUS and ERCP (n=1, 0.49%), or ERCP (n=14, 6.86%). PC was detected in 49 patients (24%). PC was strongly associated with CBD dilation, detected in the emergency ultrasound (p<0.001; OR=27; 95% CI: 5.8–185.5), increased blood levels of gamma glutamyl transpeptidase, detected at 72h (p=0.008; OR=3.4; 95% CI: 1.5–8.9); and biliary sludge in the gallbladder (p=0.008; OR=0.03; 95% CI: 0.001–0.3).

Conclusions

The predictive model showed a validated area under the curve (AUC) of 0.858 for detecting PC in patients with ABP. A nomogram was developed based on model results.

Conclusions

The predictive model was highly effective in detecting PC in patients with ABP. Therefore, this model could be useful in clinical practice.

Keywords:
Choledocolitiasis
Acute biliary pancreatitis
Predictive model
Magnetic resonance imaging cholangiography
Endoscopic retrograde cholangiopancreatography
Abbreviations:
ABP
ALT
AST
CBD
CI
CT
ERCP
EUS
GGT
LFT
MRCP
NV
PC
ROC-AUC
Resumen
Antecedentes

La coledocolitiasis que provoca una pancreatitis aguda biliar (PAB) puede migrar al duodeno o persistir en el conducto biliar común (CBC). Desarrollamos un modelo para predecir la coledocolitiasis persistente (CP) en pacientes con PAB.

Métodos

Este estudio de cohortes retrospectivo incluyó a 204 pacientes, edad ≥ 18 años (edad media: 73 años, 65,7% mujeres), ingresados por PAB entre los años 2013 y 2018, a los que se les realizó al menos una colangiopancreatografía por resonancia magnética (CPRM), una ultrasonografía endoscópica (USE) o una colangiopancreatografía retrógrada endoscópica (CPRE). Se compararon variables epidemiológicas, analíticas, de imagen y endoscópicas entre pacientes con y sin CP. Se realizaron análisis de regresión logística multivariante para desarrollar un modelo predictivo de CP.

Resultados

Los pacientes se sometieron a CPRM (n=145, 71,1%), CPRM y CPRE (n=44, 21,56%), USE y CPRE (n=1, 0,49%) o CPRE (n=14, 6,86%). Se detectó CP en 49 pacientes (24%). La CP se asoció fuertemente con la dilatación del colédoco, detectada en la ecografía de urgencias (p <0,001; OR=27; IC del 95%: 5,8-185,5), aumento de los niveles sanguíneos de gamma glutamil transpeptidasa, detectados a las 72h (p=0,008; OR=3,4, IC del 95%: 1,5-8,9), y barro biliar en la vesícula (p=0,008; OR=0,03; IC del 95%: 0,001-0,3). El modelo predictivo alcanzó un área bajo la curva validada de 0,858 para la detección de CP en pacientes con PAB. Se desarrolló un nomograma basado en los resultados del modelo.

Conclusiones

El modelo predictivo fue altamente efectivo en la detección de CP en pacientes con PAB. Por lo tanto, este modelo podría ser útil en la práctica clínica.

Palabras clave:
Coledocolitiasis
Pancreatitis aguda biliar
Modelo predictivo
Colangiografía por resonancia magnética
Colangiopancreatografía retrógrada endoscópica

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