Evaluation of acute physiology and chronic health evaluation IV predictive scoring as mortality predictor among individual with cholangitis

Muhammad Yusuf, Nurhayat Usman, Reno Rudiman, Muhammad Bayu Z. Hutagalung


Background: Evaluation of the effectiveness of care and clinical outcomes in critically ill patients is dependent on predictive scoring models that calculate measures of disease severity and mortality. Cholangitis is an infection and obstruction of the biliary system. The APACHE IV scoring system is a logistic regression model incorporating physiologic and laboratory parameters. APACHE IV is the most updated scoring system for Intensive Care Unit (ICU) mortality prediction.

Methods: A cohort study with 65 cholangitis patient that fulfilled diagnostic criteria of Tokyo guideline 2013 was included. The APACHE IV score was assessed during first day admission to ICU. APACHE IV score and predicted mortality rate was calculated and evaluated using the area under the ROC curve (AUROC).

Results: Overall in-hospital mortality was 26.2 %. The APACHE IV score mean was 76.7 with the highest score was 133 point. AUROC of the APACHE IV score was 0.97 with the cut point of 0.87, 95% CI (0.94, 0.91) indicating good performance in this cohort.

Conclusions: APACHE IV scoring system has good discrimination in the prediction of mortality models for cholangitis patients.


Cholangitis, Infection, Outcomes, Prognostic scoring

Full Text:



Boutros C, Espat NJ. Cholangitis in Biliary Infection and Infestation of Blumgart surgery of the liver. Biliary Tract and Pancreas. 5th ed. Elseveir Saunder. 2012;(1):670.

Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepato‐Biliary‐Pancreatic Surg. 2007 Jan;14(1):15-26.

Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. Guidelines On The Management Of Common Bile Duct Stones (CBDS). Gut. 2008;57(7):1004-21.

Hasan Sadikin Hospital. Medical Record of Cholangitis Patients in 2015-2016. Meical Record Section Hasan Sadikin Hospital, 2016.

Bhattacharyya M, Todi S. APACHE IV: benchmarking in an Indian ICU. Critical Care. 2009 Mar;13(1):P510.

Knaus WA, Wagner DP, Zimmerman JE, Draper EA. Variations in mortality and length of stay in intensive care units. Annals Inter Med. 1993 May 15;118(10):753-61.

Schneider J, Hapfelmeier A, Thöres S, Obermeier A, Schulz C, Pförringer D, et al. Mortality Risk Factor For Acute Cholangitis (MAC) A Risk Prediction Model For In-Hospital Mortality With Acute Cholangitis. BMC Gastroenterology J. 2016 (16):15

Allam H, Al Dosouky M, Abdelaziem S, Hashish MS, Farooq A, El Nagar A. Acute calcular cholangitis in a diverse multi-ethnic population. Inter J Surg Open. 2016 Jan 1;2:22-5.

Ito T, Sai JK, Okubo H, Saito H, Ishii S, Kanazawa R, et al. Safety of immediate endoscopic sphincterotomy in acute suppurative cholangitis caused by choledocholithiasis. World J Gastrointestinal Endoscopy. 2016 Feb 10;8(3):180.

Chetana V. Infections of the Gastrointestinal System. JP Medical. 2013:511.

Lim JH. Liver Flukes: The Malad Neglected. Korean J Radiol. 2011:12(3):269-79.

Henry AP, Thomas RG. Anatomy, embryology, anomalies and physiology of biliary tract chapter 102 in Shackelford’s surgery of the alimentary tract. Elsevier Saunder;2013:530.

Beckingham, IJ. ABC of diseases of liver, pancreas, and biliary system gallstone disease: BMJ. 2001(322):7278:91-94.

Villegas L, Pappas TN. Cholangitis management operative cholecystitis and cholelithiasis. In: Shackelford’s Surgery of the alimentary tract. Elseveir Saunder;2013:654.

Chan T, Bleszyniski MS, Buczkowski AK. Evaluation of apache iv predictive scoring in surgical abdominal sepsis: a retrospective cohort study. J Clin Diagn Res. 2016;10(3):16-8.

Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: Hospital Mortality Assessment for Today's Critically Ill Patients. Crit Care Med. 2016;34(5):1297-310.

Choi JW, Park YS, Lee YS, Park YH, Chung C, Park DI, et al. The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV score to predict mortality in a single tertiary hospital. Korean J Crit Care Med. 2016;32(3):275-83.