Characteristics and clinical outcomes of acute cholangitis in older patients

PurposeFew studies are available on older patients with acute cholangitis. In this study, we aimed to examine the clinical characteristics of older patients with acute cholangitis.MethodsPatients aged 65 years and over who were diagnosed with acute cholangitis between February 2019 and August 2022 were analyzed retrospectively. Patients eligible for the study were divided into two groups as those aged >= 80 years (octogenarian) and those aged 65-79 years (non-octogenarian). These two groups were then compared for many clinical characteristics. In addition, factors associated with in-hospital mortality were identified. Finally, a subgroup analysis was performed in patients with non-malignant etiology.ResultsOf a total of 309 enrolled patients, 120 (38.8%) were in the octogenarian group and 189 (61.2%) were in the non-octogenarian group. The mean age was 77.2 +/- 8.0 years and 51.8% were women. Severe disease and intensive care unit admission rates were higher in the octogenarian group (p = 0.035 and p = 0.002, respectively), but there was no significant difference in the rate of in-hospital mortality (p = 0.146). Malignant etiology (OR 2.990, 95% CI 1.131-7.904) and hypoalbuminemia (OR 0.824, 95% CI 0.751-0.903) were independent risk factors for in-hospital mortality. In the subgroup analysis of non-malignant etiology, the octogenarian group had a significantly higher in-hospital mortality rate than the non-octogenarian group (8.8% vs. 3.2%, p = 0.048).ConclusionsAmong older patients with acute cholangitis, clinicians should closely monitor those aged 80 years and over, as well as those with malignant etiology and hypoalbuminemia, due to their high risk of serious clinical events. Key summary pointsAimThe aim of this study was to determine mortality-related factors in older patients with acute cholangitis and to compare the clinical characteristics of patients aged 65-79 years and >= 80 years.FindingsMalignant etiology and hypoalbuminemia were independent risk factors for in-hospital mortality in older patients with acute cholangitis. Being 80 years or older was associated with severe disease in the entire patient population, whereas it was associated with in-hospital mortality in the subgroup of patients with non-malignant etiology.MessageIn older patients with acute cholangitis, closer monitoring seems appropriate in those with malignant etiology and hypoalbuminemia, as well as those aged 80 years and over.