Malignant biliary obstructions: can we predict immediate postprocedural cholangitis after percutaneous biliary drainage?

Percutaneous transhepatic biliary drainage (PTBD) is performed for the palliation of malignant biliary obstructions. The purpose of this study was to identify factors related to the occurrence of immediate cholangitis as a complication after PTBD We retrospectively assessed 409 apparently stable patients with malignant biliary obstruction who underwent PTBD between January 2008 and December 2010. New onset cholangitis was defined as fever (> 38 A degrees C) that arose within 24 h after the intervention. Variables significantly associated with the occurrence of immediate cholangitis were selected and their odds ratio and 95 % confidence interval were calculated using logistic regression analysis. There were 106 (25.9 %) cases of immediate cholangitis following PTBD, and among those 106 cases, 45 (42.5 %) had sepsis. In multivariate analysis, history of cholangitis (OR 4.7, 95 % CI 2.45-9.18), biliary drainage within 6 months (OR 2.3, 95 % CI 1.26-4.15), CRP a parts per thousand yen5 mg/dL (OR 2.2, 95 % CI 1.23-4.03), and serum albumin < 3 g/dL (OR 1.9, 95 % CI 1.023-3.40) were predictive of immediate cholangitis after PTBD for malignant biliary obstructions. Cholangitis is a common immediate complication after PTBD. Patients should always be given prophylactic antibiotics before the drainage procedures. The results of this study could highlight the patients who require closer follow-up in order to make PTBD a safer procedure.