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Objective: To investigate the relationship between serum Presepsin, immunosuppressive acid protein (IAP), high mobility group B1 (HMGB1) and prognosis of percutaneous transhepatic cholangial drainage (PTCD) treatment in patients with acute obstructive suppurative cholangitis (AOSC). Methods: 220 patients with AOSC who received PTCD treatment in the Baoding Second Central Hospital from January 2021 to January 2023 were selected to be included in the AOSC group, and 88 healthy volunteers during the same period were selected to be included in the control group. The patients with AOSC were divided into survival group with 36 cases and death group with 184 cases according to whether they died during hospitalization after PTCD surgical. Serum Presepsin, IAP and HMGB1 levels were detected. Multivariate Logistic regression model was used to analyze the factors affecting the prognosis of PTCD surgical treatment in patients with AOSC, the predictive value of serum Presepsin, IAP and HMGB1 levels on postoperative death in patients with AOSC after PTCD surgical was analyzed by receiver operating characteristic (ROC) curve. Results: The serum Pressin, IAP, and HMGB1 levels in the AOSC group were higher than those in the control group (P＜0.05). The mortality rate during hospitalization after PTCD surgical in 220 patients with AOSC was 16.36% (36/220). Multivariate Logistic regression analysis showed that, time from onset to surgery ≥3 d, 24 h postoperative bile drainage ＜300 m L, elevated Presepsin, elevated IAP, and elevated HMGB1 were independent risk factors affecting the prognosis of PTCD treatment in patients with AOSC (P＜0.05). ROC curve analysis showed that, the area under the curve of serum Presepsin, IAP, and HMGB1 levels combined to predict postoperative death after PTCD surgical in patients with AOSC was 0.920, which was greater than the single indicator prediction. Conclusion: Elevated serum Presepsin, IAP, and HMGB1levels in patients with AOSC are independent risk factors for the prognosis of PTCD treatment. The combination of serum presepsin, IAP, and HMGB1 levels has high value in predicting the prognosis of PTCD treatment in patients with AOSC. [ABSTRACT FROM AUTHOR]