{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T16:14:01Z","timestamp":1770740041532,"version":"3.49.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The association between acute cholangitis (AC) and acute kidney injury (AKI) remains unclear. We investigated the incidence, and clinical course of AKI in patients with AC, and the long-term prognosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We performed a single-center retrospective study of patients hospitalized with AC in a tertiary care center from January 2011 to December 2017. The risk factors for AKI were evaluated, and AKI severity was analyzed using the Systemic Inflammatory Response System (SIRS), quick sequential organ failure assessment (qSOFA) score, and 2018 Tokyo Guidelines (TG) grade. To calculate the relative risk of death based on AKI, hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using Cox\u2019s proportional hazard models.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 1,438 patients with AC were included, of whom 18.2% (n = 261) developed AKI. AKI patients were older, and had a lower systolic blood pressure and more comorbidities including hypertension (HT), chronic kidney disease, and cardiovascular accidents. Disease severity (as assessed by SIRS, qSOFA, and the Tokyo Guidelines grade) was higher in the AKI group, as was the in-hospital mortality rate. Multivariate analysis revealed that age, HT, SIRS and qSOFA scores \u2265 2, and TG grade of III were significant risk factors for AKI. Kaplan-Meier analysis revealed significantly higher mortality in the AKI than non-AKI group. AKI (HR = 1.853; 95% CI: 1.115\u20133.079) and TG grade III (HR = 2.139; 95% CI: 1.190\u20133,846) were independent predictors of all-cause AC mortality, even after adjusting for all covariates. The annual rate of decline in the estimated glomerular filtration rate was faster in the AKI than non-AKI group (2.9 \u00b1 6.7 vs. 0.5 \u00b1 5.3 mL\/min\/1.73 m<jats:sup>2<\/jats:sup>\/year, <jats:italic>p<\/jats:italic> &lt; 0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>AKI development increased AC severity and mortality. Our results suggest that clinicians should monitor AKI status and perform appropriate management as soon as possible.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0267023","type":"journal-article","created":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T17:37:32Z","timestamp":1649957852000},"page":"e0267023","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Incidence, risk factors, and prognosis of acute kidney injury in hospitalized patients with acute cholangitis"],"prefix":"10.1371","volume":"17","author":[{"given":"Tae Won","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wooram","family":"Bae","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seongmin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jungyoon","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunjin","family":"Bae","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ha Nee","family":"Jang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Se-Ho","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5233-537X","authenticated-orcid":true,"given":"Dong Jun","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,4,14]]},"reference":[{"key":"pone.0267023.ref001","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0002-9610(05)80930-4","article-title":"Natural history of asymptomatic and symptomatic gallstones","volume":"165","author":"GD Friedman","year":"1993","journal-title":"Am J Surg"},{"key":"pone.0267023.ref002","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1155\/1995\/74384","article-title":"Review article: Spectrum of biliary infections in the West and in the East","volume":"8","author":"HG Beger","year":"1995","journal-title":"HPB Surg"},{"key":"pone.0267023.ref003","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1164\/rccm.201310-1875OC","article-title":"Association between source of infection and hospital mortality in patients who have septic shock","volume":"189","author":"A Leligdowicz","year":"2014","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0267023.ref004","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s13054-018-2013-1","article-title":"Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study","volume":"22","author":"N Baykara","year":"2018","journal-title":"Crit Care"},{"key":"pone.0267023.ref005","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1164\/rccm.2201087","article-title":"Current epidemiology of septic shock: the CUB-R\u00e9a network","volume":"168","author":"D Annane","year":"2003","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0267023.ref006","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1007\/s00134-016-4504-3","article-title":"Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study","volume":"42","author":"SepNet Critical Care Trials Group","year":"2016","journal-title":"Intensive Care Med"},{"key":"pone.0267023.ref007","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s00534-002-0710-1","article-title":"Management of cholangitis","volume":"10","author":"PC Bornman","year":"2003","journal-title":"J Hepatobiliary Pancreat Surg"},{"key":"pone.0267023.ref008","doi-asserted-by":"crossref","first-page":"4583493","DOI":"10.1155\/2021\/4583493","article-title":"Factors associated with mortality in severe acute cholangitis in a Moroccan intensive care unit: A retrospective analysis of 140 cases","volume":"2021","author":"S Touzani","year":"2021","journal-title":"Gastroenterol Res Pract"},{"key":"pone.0267023.ref009","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s00534-006-1152-y","article-title":"Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines","volume":"14","author":"Y Kimura","year":"2007","journal-title":"Journal of Hepato-Biliary-Pancreatic Surgery"},{"key":"pone.0267023.ref010","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00534-006-1151-z","article-title":"Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines","volume":"14","author":"M Sekimoto","year":"2007","journal-title":"Journal of Hepato-Biliary-Pancreatic Surgery"},{"key":"pone.0267023.ref011","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s00534-012-0564-0","article-title":"TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis","volume":"20","author":"Y Kimura","year":"2013","journal-title":"Journal of Hepato-Biliary-Pancreatic Sciences"},{"key":"pone.0267023.ref012","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/jhbp.509","article-title":"Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis","volume":"25","author":"F Miura","year":"2018","journal-title":"J Hepato-Biliary Pancreatic Sciences"},{"key":"pone.0267023.ref013","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/jhbp.458","article-title":"Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study","volume":"24","author":"S Kiriyama","year":"2017","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"pone.0267023.ref014","doi-asserted-by":"crossref","first-page":"3365","DOI":"10.1681\/ASN.2004090740","article-title":"Acute kidney injury, mortality, length of stay, and costs in hospitalized patients","volume":"16","author":"GM Chertow","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"pone.0267023.ref015","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1001\/jama.294.7.813","article-title":"Acute renal failure in critically ill patients: a multinational, multicenter study","volume":"294","author":"S Uchino","year":"2005","journal-title":"JAMA"},{"key":"pone.0267023.ref016","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/01.CCM.0000194725.48928.3A","article-title":"Sepsis in European intensive care units: results of the SOAP study","volume":"34","author":"JL Vincent","year":"2006","journal-title":"Crit Care Med"},{"key":"pone.0267023.ref017","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1097\/01.CCM.0000277041.13090.0A","article-title":"Acute kidney injury in the intensive care unit according to RIFLE","volume":"35","author":"M Ostermann","year":"2007","journal-title":"Crit Care Med"},{"key":"pone.0267023.ref018","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1378\/chest.09-3071","article-title":"Incidence and prognostic implications of acute kidney injury on admission in patients with community acquired pneumonia","volume":"138","author":"AR Akram","year":"2010","journal-title":"Chest"},{"key":"pone.0267023.ref019","doi-asserted-by":"crossref","first-page":"R73","DOI":"10.1186\/cc4915","article-title":"RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis","volume":"10","author":"EAJ Hoste","year":"2006","journal-title":"Crit Care"},{"key":"pone.0267023.ref020","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1053\/j.ajkd.2003.12.045","article-title":"Clinical characteristics of patients developing ARF due to sepsis\/ systemic inflammatory response syndrome: results of a prospective study","volume":"43","author":"I Yegenaga","year":"2004","journal-title":"Am J Kidney Dis"},{"key":"pone.0267023.ref021","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1164\/ajrccm.161.3.9809066","article-title":"Initial versus delayed acute renal failure in the intensive care unit. A multicenter prospective epidemiological study. Rhone- Alpes Area Study Group on Acute Renal Failure","volume":"161","author":"C Guerin","year":"2000","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0267023.ref022","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1097\/01.ASN.0000059863.48590.E9","article-title":"Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome","volume":"14","author":"EAJ Hoste","year":"2003","journal-title":"J Am Soc Nephrol"},{"key":"pone.0267023.ref023","first-page":"1","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury","volume":"2","author":"KDIGO","year":"2012","journal-title":"Kidney Int Suppl"},{"key":"pone.0267023.ref024","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1097\/00000658-197506000-00022","article-title":"Cholangitis with acute renal failure: priorities in therapeutics","volume":"181","author":"H Bismuth","year":"1975","journal-title":"Ann Surg"},{"key":"pone.0267023.ref025","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1136\/pgmj.51.598.510","article-title":"Renal failure in obstructive jaundice-clinical aspect","volume":"51","author":"JL Dawson","year":"1975","journal-title":"Postgrad Med J"},{"key":"pone.0267023.ref026","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1378\/chest.101.6.1644","article-title":"Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP\/ SCCM Consensus Conference Committee. American College of Chest Physicians\/Society of Critical Care Medicine","volume":"101","author":"RC Bone","year":"1992","journal-title":"Chest"},{"key":"pone.0267023.ref027","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.annemergmed.2016.03.018","article-title":"No SIRS; quick SOFA instead","volume":"67","author":"JS Faust","year":"2016","journal-title":"Ann Emerg Med"},{"key":"pone.0267023.ref028","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1164\/rccm.201604-0854OC","article-title":"qSOFA, SIRS, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients Outside the ICU","volume":"195","author":"MM Churpek","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0267023.ref029","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1164\/rccm.201502-0329OC","article-title":"Acute kidney injury requiring dialysis in severe sepsis","volume":"192","author":"A Sakhuja","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0267023.ref030","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"M Singer","year":"2016","journal-title":"JAMA"},{"key":"pone.0267023.ref031","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1080\/0886022X.2019.1591995","article-title":"Incidence, risk factors, and clinical outcomes of acute kidney injury associated with acute pyelonephritis in patients attending a tertiary care referral center","volume":"41","author":"D Jeon","year":"2019","journal-title":"Ren Fail"},{"key":"pone.0267023.ref032","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1007\/s00134-003-1662-x","article-title":"2001 SCCM\/ESICM\/ACCP\/ATS\/ SIS International Sepsis Definitions Conference","volume":"29","author":"MM Levy","year":"2003","journal-title":"Intensive Care Med"},{"key":"pone.0267023.ref033","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/jhbp.512","article-title":"Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)","volume":"25","author":"S Kiriyama","year":"2018","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"pone.0267023.ref034","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1002\/jhbp.9","article-title":"Comparison of two editions of Tokyo guidelines for the management of acute cholangitis","volume":"21","author":"G Sun","year":"2014","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"pone.0267023.ref035","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1186\/s13054-016-1353-y","article-title":"Acute kidney injury: short-term and long-term effects","volume":"20","author":"F Doyle","year":"2016","journal-title":"Critical Care"},{"key":"pone.0267023.ref036","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1053\/j.ajkd.2008.11.034","article-title":"Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis","volume":"53","author":"SG Coca","year":"2009","journal-title":"Am J Kidney Dis"},{"key":"pone.0267023.ref037","doi-asserted-by":"crossref","first-page":"2555","DOI":"10.2215\/CJN.09560911","article-title":"Acute kidney injury and chronic kidney disease: a work in progress","volume":"6","author":"JR Bydash","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"pone.0267023.ref038","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1038\/ki.2011.379","article-title":"Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis","volume":"81","author":"SG Coca","year":"2012","journal-title":"Kidney Int"},{"key":"pone.0267023.ref039","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1038\/ki.2012.208","article-title":"Acute kidney injury and chronic kidney disease: an integrated clinical syndrome","volume":"82","author":"LS Chawla","year":"2012","journal-title":"Kidney Int"},{"key":"pone.0267023.ref040","doi-asserted-by":"crossref","first-page":"e006497","DOI":"10.1136\/bmjopen-2014-006497","article-title":"Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review","volume":"4","author":"S Sawhney","year":"2015","journal-title":"BMJ Open"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267023","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T17:38:06Z","timestamp":1649957886000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267023"}},"subtitle":[],"editor":[{"given":"Mabel","family":"Aoun","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,14]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0267023","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,14]]}}}