A Prospective Evaluation of Serum MUC5AC for Predicting Malignancy in Patients With Acute Cholangitis.

OBJECTIVE: This study evaluated the diagnostic performance of serum MUC5AC for predicting malignancy in acute cholangitis patients, comparing it with CA19-9 and bilirubin. METHODS: This prospective study included 163 patients hospitalized with acute cholangitis. Serum MUC5AC was measured by ELISA within 24 h of admission. Clinical, laboratory, imaging, and pathological findings were reviewed to categorize patients into benign or malignant groups. RESULTS: Multivariate analysis identified MUC5AC and total bilirubin as independent predictors of malignant cholangitis. Higher MUC5AC (OR: 1.2385, 95% CI: 1.0906-1.4065, p = 0.0006) and elevated total bilirubin (OR: 1.2086, 95% CI: 1.1068-1.3197, p < 0.001) were independently associated with malignancy. CA19-9 was significantly associated with malignant cholangitis in univariate analysis but lost significance in multivariate analysis. Among malignant cases, median MUC5AC levels were significantly higher in metastatic than resectable patients, suggesting an association between elevated MUC5AC and advanced disease stage. CONCLUSION: MUC5AC is a promising biomarker for predicting malignant etiology in acute cholangitis, offering additional diagnostic value alongside established markers like CA19-9 and total bilirubin.