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Cardiovasc Intervent Radiol. 2016 May;39(5):746-55. doi: 10.1007/s00270-015-1242-9. Epub 2015 Nov 24.

Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage.

Author information

  • 1Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. pierleone.lucatelli@gmail.com.
  • 2Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
  • 3Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
  • 4Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy.
  • 5Department of Vascular Interventional Radiology of the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Abstract

OBJECTIVES:

To prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD).

METHODS:

Institutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF.

RESULTS:

Fourteen (14.4%) patients developed IF and 17 (17.5%) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95% CI 2.658-1510.055; P = 0.010) and low INR (OR 4.7 × 10(-4); 95% CI 0.000-0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95% CI 1.161-17.992; P = 0.030).

CONCLUSIONS:

The amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.

KEYWORDS:

Bile duct dilatation; Contrast media volume; Fever; Percutaneous transhepatic biliary drainage; Unsatisfactory biliary drainage

PMID:
26604112
DOI:
10.1007/s00270-015-1242-9
[PubMed - indexed for MEDLINE]
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