BACKGROUND
Cardiac dysfunction seen among patients with hepatobiliary pathologies increases the risk for morbidity and mortality. In particular, comorbid heart failure (HF) affects the hepatobiliary system through its impact on the body’s hemodynamics which in turn causes damage to the liver and biliary system. Although previous studies suggested that HF adversely impacts the long-term outcomes of patients with hepatobiliary pathologies, there is paucity of data regarding the in-hospital outcomes of patients with acute cholangitis and comorbid HF.

METHODSs
We queried the National Inpatient Sample (NIS) to identify patients with HF who were hospitalized for acute cholangitis during the index hospitalization using appropriate ICD-10 codes between 2018-2020. We aim to investigate the impact of HF among acute cholangitis patients based on in-hospital mortality, risk for acute respiratory failure and severe sepsis, utilization of mechanical ventilation, and length of stay (LOS). A multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest.

RESULTS
A total of 27050 hospitalized patients with acute cholangitis were identified, of which 8.17% (2210/27050) had concomitant HF during the index hospitalization. The overall in-hospital mortality rate among hospitalized patients with acute cholangitis was 0.7% (189/27050). Among those with concomitant HF, the in-hospital mortality rate was deemed to be significantly elevated to 2.49% (55/2210, p= <0.001) compared to those who did not have HF. After adjusting for possible confounders, concomitant HF among hospitalized acute cholangitis patients was found to be an independent predictor of increased risk for in-hospital mortality (aOR 2.32; 95% CI, 1.01-5.45; p=0.049), acute respiratory failure (aOR 3.77; 95% CI, 2.33-6.10; p=<0.001), and prolonged LOS (coefficient 1.34; 95% CI 0.81-1.86,p=<0.001), however, it was not associated with increased risk for severe sepsis (aOR 1.86; 95% CI,0.96-3.59; p=0.071) or mechanical ventilation utilization (aOR 1.72; 95% CI, 0.74-4.01; p=0.213).

CONCLUSION
Our analysis showed that HF among hospitalized acute cholangitis patients was independently associated with increased risk for adverse in-hospital outcomes. This is likely due to the elaborate hemodynamic alterations seen among heart failure patients which subsequently affects the evaluation and management of patients with acute cholangitis especially if administration of intravenous fluid is warranted. Therefore, efforts should be focused on the evaluation and treatment of HF in order to mitigate its adverse impact among hospitalized patients with acute cholangitis.

Michael Goldberg

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