Clinical Profile, Management and Outcomes of Acute Cholangitis: 5 Years Experience at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background Acute cholangitis is an acute inflammation and infection within the biliary tree that is usually secondary to mechanical obstruction, such as choledocholithiasis, malignant biliary obstruction, benign strictures, ampullary or duodenal obstruction, and stent blockade or dysfunction of the sphincter of Oddi. Accurate and up-to-date epidemiological data concerning acute cholangitis are relatively scarce, especially in sub-Saharan African countries. This study on the clinical profile and management of acute cholangitis holds significant importance for both clinical practice and public health by characterizing the clinical presentation and demographic features of patients with acute cholangitis. Methods The study was conducted at Tikur Anbessa Specialized Hospital, the largest healthcare facility in Ethiopia, which is located in Addis Ababa. The study covered a five-year period, from January 2020 to December 2024. A hospital-based retrospective study was conducted. Data were obtained from the medical records of patients (charts) diagnosed with cholangitis. Bivariable and multivariable logistic regression were used, and statistical significance was set at a p value < 0.05 to compare independent variables with outcomes. Results The medical records of 81 patients with a diagnosis of acute cholangitis fulfilling the inclusion criteria were included in the study. The mean age of the patients was 53.96 years, and 56.8% were female. The most common etiology was choledocholithiasis (50.6%). Jaundice (95.1%) and RUQ-related abdominal pain (71.6%) were the most common presenting symptoms. Medical management alone was successful in 85.2% of the patients. Adverse outcomes, including liver abscess, intensive care unit (ICU) admission, and two deaths (2.5%), occurred in 21% of patients. Multivariate analysis revealed that age, weight loss, pulse rate, platelet count, albumin level, and prothrombin time were predictors of poor outcomes. The serum ALB concentration and PT were also associated with higher severity scores. Conclusion Acute cholangitis in this setting is primarily due to choledocholithiasis and presents late. Outcomes are generally favorable, but gaps exist in microbiologic testing and early intervention. The incorporation of the TG13 criteria for diagnosis and grading, improved access to endoscopic therapy, and early risk stratification via clinical and laboratory markers are essential for optimizing care.