Epidemiological profile, referral routes and diagnostic accuracy of cases of acute cholangitis among individuals with obstructive jaundice admitted to a tertiary-level university hospital: a cross-sectional study

ABSTRACT BACKGROUND: Obstructive jaundice may lead to ominous complications and requires complex diagnostic evaluations and therapies that are not widely available. OBJECTIVE: To analyze the epidemiological profile, referral routes and diagnostic accuracy at admittance of cases of acute cholangitis among patients with obstructive jaundice treated at a referral unit. DESIGN AND SETTING: Cross-sectional study at a tertiary-level university hospital. METHODS: Patients with obstructive jaundice who were treated by means of endoscopic retrograde cholangiopancreatography, resection and/or surgical biliary drainage were evaluated. The main variables analyzed were epidemiological data, referral route, bilirubin levels and time elapsed between symptom onset and admittance and diagnosing of acute cholangitis at the referral unit. The accuracy of the clinical diagnosis of acute cholangitis was compared with a retrospective analysis on the medical records in accordance with the Tokyo criteria. RESULTS: Female patients predominated (58%), with an average age of 56 years. Acute cholangitis was detected in 9.9% of the individuals; application of the Tokyo criteria showed that the real prevalence was approximately 43%. The main referral route was direct contact (31.8%) and emergency care (29.7%); routing via official referral through the public healthcare system accounted for 17.6%, and internal referral from other specialties, 20%. The direct route with unofficial referral was the most important route for cases of neoplastic etiology (P < 0.01) and was the fastest route (P < 0.01). CONCLUSIONS: There is a deficiency in the official referral routes for patients with obstructive jaundice. The accuracy of the clinical diagnosis of acute cholangitis was poor. Wider dissemination of the Tokyo criteria is essential.

摘要背景：梗阻性黄疸（obstructive jaundice）可引发凶险并发症，且其所需的复杂诊断评估与治疗手段普及度有限。
研究目的：分析在转诊中心接受治疗的梗阻性黄疸患者中，急性胆管炎（acute cholangitis）病例的流行病学特征、转诊途径及入院时的诊断准确性。
设计与研究场景：于三级大学附属医院开展的横断面研究。
研究方法：对接受内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）、切除术和/或外科胆道引流术治疗的梗阻性黄疸患者进行评估。分析的主要变量包括流行病学资料、转诊途径、胆红素水平、症状发作至入院的间隔时间，以及转诊中心内急性胆管炎的确诊时间。依据东京标准（Tokyo criteria），将急性胆管炎的临床诊断准确性与病历回顾性分析结果进行对比。
研究结果：女性患者占比居多（58%），平均年龄为56岁。急性胆管炎检出率为9.9%；采用东京标准评估后，实际患病率约为43%。主要转诊途径为直接就诊（31.8%）与急诊诊疗（29.7%）；通过公立医疗体系的官方转诊占比17.6%，其他专科的内部转诊占比20%。非官方直接转诊途径在肿瘤病因病例中占比最高（P < 0.01），且为最快的转诊途径（P < 0.01）。
研究结论：梗阻性黄疸患者的官方转诊途径存在不足。急性胆管炎的临床诊断准确性欠佳。推广东京标准具有重要意义。