Predicting Success in Percutaneous Transhepatic Biliary Drainage.

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  • Author(s): Khosla A;Khosla A; Xi Y; Xi Y; Toomay S; Toomay S
  • Source:
    Cardiovascular and interventional radiology [Cardiovasc Intervent Radiol] 2017 Oct; Vol. 40 (10), pp. 1586-1592. Date of Electronic Publication: 2017 May 12.
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Springer Verlag Country of Publication: United States NLM ID: 8003538 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-086X (Electronic) Linking ISSN: 01741551 NLM ISO Abbreviation: Cardiovasc Intervent Radiol Subsets: MEDLINE
    • Publication Information:
      Publication: New York Ny : Springer Verlag
      Original Publication: [Berlin, New York] Springer International.
    • Subject Terms:
      Monte Carlo Method* ; Patient Selection*; Biliary Tract Diseases/*blood ; Biliary Tract Diseases/*therapy ; Bilirubin/*blood ; Drainage/*methods; Bayes Theorem ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome
    • Abstract:
      Purpose: To develop a model to predict successful bilirubin decrease following percutaneous biliary drain placement.
      Methods: A total of 257 patients who were identified having undergone percutaneous transhepatic biliary drain placement (PTBD) at our institution between 2002 and 2013 had their medical records and imaging reviewed. Of those, 190 of these patients met criteria and were used in the analysis. A regression model was performed on logarithm-transformed collected variables to predict post-drainage logarithmic transformed total bilirubin levels. A stepwise variable selection method based on Schwarz Bayesian Information Criterion was used to select the most closely associated variables. The model was validated with a Monte Carlo simulation. A short program was developed to calculate the point estimate using the model developed and compared to actual values.
      Results: The variables that best predicted bilirubin reduction were initial Tbl (PrTbl), INR and ALT. The selected model had a root mean squared error of 0.8. The model had a negative predictive value (PoTbl is below 2 mg/dL) of 83%.
      Conclusions: PTBD may not achieve decreasing bilirubin in patients with a malignant obstruction. This is an initial model that can help determine which patients may not benefit from PTBD placement. With more patients, the model's validity can be increased and provide useful clinical determinant to aide patient care.
    • Comments:
      Comment in: Cardiovasc Intervent Radiol. 2017 Oct;40(10 ):1655. (PMID: 28664234)
      Comment in: Cardiovasc Intervent Radiol. 2017 Oct;40(10 ):1656. (PMID: 28744574)
    • Contributed Indexing:
      Keywords: Bayesian analysis; Jaundice; Percutaneous biliary drain; Predictive model; Total bilirubin
    • Accession Number:
      RFM9X3LJ49 (Bilirubin)
    • Publication Date:
      Date Created: 20170514 Date Completed: 20180614 Latest Revision: 20180614
    • Publication Date:
      20221213
    • Accession Number:
      10.1007/s00270-017-1679-0
    • Accession Number:
      28500461