Patient Frailty and Persistent Inflammation Predict Mortality After Percutaneous Cholecystostomy: Study

A new study published in the journal of BMC Surgery showed that baseline patient susceptibility and a sustained early inflammatory response following the surgery were the main causes of in-hospital death after percutaneous cholecystostomy (PC).

Percutaneous cholecystostomy is an important therapy for acute cholecystitis in critically unwell patients, although in-hospital mortality remains high. Identifying early clinical predictors, such as advanced age, severe sepsis, and multiorgan failure, is critical.

These markers allow for rapid risk categorization, which helps doctors optimize intensive care and improve overall patient survival results. However, the parameters associated with in-hospital mortality and the influence of radiologic disease burden following PC remain poorly understood. As a result, this study was performed to identify such indicators.

This study included consecutive adult patients who had image-guided PC for acute cholecystitis between January 2022 and December 2025 in this retrospective single-center cohort analysis. Radiologic, analytical, clinical, and procedural factors were examined.

Multivariable logistic regression analysis was used to assess factors linked to in-hospital mortality. Pericholecystic fluid, emphysematous cholecystitis, gallbladder perforation, and gallbladder wall thickness > 7 mm were among the specified imaging abnormalities used to create an exploratory radiologic severity score (RSS). Additionally, correlations between RSS and the inflammatory response after PC were evaluated.

There were 266 patients in all (mean age 64.9 ± 17.1 years; 56.4% male). With 20 patients, the total in-hospital death rate was 7.5%. Older age (OR, 2.06 per

10-year increase, 95% CI, 1.25–3.39), cancer (OR, 9.19, 95% CI, 2.71–31.22), increased LDH (OR, 1.86 per 100 U/L increase, 95% CI, 1.23–2.81), and higher post-procedural day-3 CRP levels (OR, 2.17 per 50 mg/L increase, 95% CI, 1.32–3.55) were all independently linked to in-hospital mortality.

In internal validation, the multivariable model showed strong discriminative performance (cross-validated AUC: 0.895). Reduced CRP decline after PC was linked to higher RSS values (p = 0.041), indicating a slower resolution of inflammation. RSS did not, however, have a significant correlation with either hospital duration of stay or death.

Overall, cholecystostomy was significantly linked to baseline patient susceptibility and a prolonged early inflammatory response following the procedure. Radiologic disease load appears to be associated with inflammatory recovery rather than death. Further, detailed prospective multicenter investigations are required to validate these findings.

Source:

Senol, A., & Kavak, S. (2026). Early predictors of in-hospital mortality after percutaneous cholecystostomy. BMC Surgery. https://doi.org/10.1186/s12893-026-03920-1