Platelet index on admission as a predictor of bacteremia in acute cholangitis: a 7-year retrospective observational study

Abstract

Bacteremia frequently occurs in patients with acute cholangitis, which could increase the risk of mortality. This single-center retrospective observational study was conducted from July 2013 to July 2020 to evaluate the predictive value of platelet index for bacteremia at admission for acute cholecystitis. A total of 285 patients with acute cholangitis were divided into bacteremia group and non-bacteremia group. The incidence of bacteremia in acute cholangitis was 48.42%. The bacteremia group had more grade III patients, higher 30d mortality rate [17(12.32%) vs 8(5.44%), p = .040] and higher incidence of thrombocytopenia [76(55.07%) vs 35(23.81%), p < .001]. Platelet counts and plateletcrit were significantly lower in the bacteremia group [84.5(60, 180) vs 162(102,225) ×10⁹/L and 0.10(0.07, 0.21)% vs 0.18(0.12, 0.25) %, both p < .001]. ROC analysis indicated a high predictive value of platelet count and plateletcrit for bacteremia in patients with acute cholangitis and the area under the ROC curve (AUC) were 0.649 and 0.655, respectively. These results support the value of platelet count and plateletcrit in early prediction of bacteremia at admission for acute cholangitis.

Plain Language Summary

What is the context?

• Acute cholangitis is a fatal infectious disease. Bacteremia frequently occur in patients with acute cholangitis, which could increase the risk of mortality.

• The positive rate of blood cultures in patients with acute cholangitis ranged from 21% to 71%.

• Platelets play key roles in thromboembolism, inflammation, and immune regulation.

• To the best of our knowledge, whether platelet index facilitates to the diagnosis of bacteremia in acute cholangitis has not been investigated.

What is new?

• In this study, we designed this 7-year retrospective, observational study to verify that platelet index could contribute to the early diagnosis of bacteremia in acute cholangitis.

• The results showed that:

• The patients with bacteremia had a higher incidence of thrombocytopenia.

• Thrombocytopenia, platelet count, plateletcrit, and procalcitonin were independent risk factors for bacteremia in acute cholangitis

• Platelet count and plateletcrit had positive predictive value for bacteremia in acute cholangitis.

What is the impact?

• This study presents clinical characteristics of acute cholangitis complicated by bacteremia, and provides evidence that platelet index can be used to predict bacteremia in acute cholangitis.

Keywords:

• Acute cholangitis
• bacteremia
• platelet
• thrombocytopenia

Authorship

XiaoYing Chen contributed to the conception of the study, performed the data analysis, and wrote the manuscript. Shijing TIAN performed data collection. Fu WEI wrote the manuscript. Dan ZHANG and Shijing TIAN contributed significantly to analysis and manuscript preparation. Dan ZHANG helped perform the analysis with constructive discussions. All authors read and approved the final manuscript.

Availability of data and materials

The clinical data for all patients were collected by the authors and are truly available.

Disclosure statement

No potential conflict of interest was reported by the author(s)

Informed consent

The Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University approved our study (No. 2022-K132). As this was a retrospective study, the informed consent was waived by the Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University

Ethical approval and human rights statement

The observational study was approved by an hospital ethical committees and there were no human rights violations.

Additional information

Funding

This study was supported by the Chongqing Science and Health Joint Medical Research Project (Project Number 2021MSXM015). The funder made significant contributions to the design and analysis of the study. Funding body play a facilitating role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.