Keun Soo Ahn1, Yoo-Seok Yoon2, Ho-Seong Han3, Jai Young Cho3. 1. Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. 2. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea. yoonys@snubh.org. 3. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
Abstract
BACKGROUND: Prior studies have examined the use of liver function tests (LFT) for predicting the presence of common bile duct (CBD) stones in chronic cholecystitis (CC) patients. It is currently unclear whether LFT are also useful for predicting CBD stones in patients with acute cholecystitis (AC). METHODS: Of 1059 patients who visited an emergency room with gallbladder-related symptoms between March 2004 and December 2009, 854 patients were analyzed, and were divided into three groups (556 AC patients without CBD stones (AC - CBD), 98 AC patients with CBD stones (AC + CBD), and 200 CC patients without CBD stones). We compared the LFT values at admission and the changes in LFT values over time following admission among the three groups. RESULTS: The LFT values were significantly greater in the AC + CBD group than in the AC - CBD groups. Of all the LFT variables analyzed, γ-glutamyl transpeptidase was the most reliable variable for predicting the presence of CBD stones, with a sensitivity of 80.6 % and a specificity of 75.3 % at the cut-off level of 224 IU/L. The elevated LFT values decreased significantly from the start of the follow-up assessment to before cholecystectomy in the AC - CBD group, but were unchanged before stone removal in the AC + CBD group. CONCLUSION: The LFT values on initial admission and the changes in LFT values over time are reliable predictors of CBD stones in patients with AC.
BACKGROUND: Prior studies have examined the use of liver function tests (LFT) for predicting the presence of common bile duct (CBD) stones in chronic cholecystitis (CC) patients. It is currently unclear whether LFT are also useful for predicting CBD stones in patients with acute cholecystitis (AC). METHODS: Of 1059 patients who visited an emergency room with gallbladder-related symptoms between March 2004 and December 2009, 854 patients were analyzed, and were divided into three groups (556 AC patients without CBD stones (AC - CBD), 98 AC patients with CBD stones (AC + CBD), and 200 CC patients without CBD stones). We compared the LFT values at admission and the changes in LFT values over time following admission among the three groups. RESULTS: The LFT values were significantly greater in the AC + CBD group than in the AC - CBD groups. Of all the LFT variables analyzed, γ-glutamyl transpeptidase was the most reliable variable for predicting the presence of CBD stones, with a sensitivity of 80.6 % and a specificity of 75.3 % at the cut-off level of 224 IU/L. The elevated LFT values decreased significantly from the start of the follow-up assessment to before cholecystectomy in the AC - CBD group, but were unchanged before stone removal in the AC + CBD group. CONCLUSION: The LFT values on initial admission and the changes in LFT values over time are reliable predictors of CBD stones in patients with AC.
Authors: Michele Pisano; Niccolò Allievi; Kurinchi Gurusamy; Giuseppe Borzellino; Stefania Cimbanassi; Djamila Boerna; Federico Coccolini; Andrea Tufo; Marcello Di Martino; Jeffrey Leung; Massimo Sartelli; Marco Ceresoli; Ronald V Maier; Elia Poiasina; Nicola De Angelis; Stefano Magnone; Paola Fugazzola; Ciro Paolillo; Raul Coimbra; Salomone Di Saverio; Belinda De Simone; Dieter G Weber; Boris E Sakakushev; Alessandro Lucianetti; Andrew W Kirkpatrick; Gustavo P Fraga; Imitaz Wani; Walter L Biffl; Osvaldo Chiara; Fikri Abu-Zidan; Ernest E Moore; Ari Leppäniemi; Yoram Kluger; Fausto Catena; Luca Ansaloni Journal: World J Emerg Surg Date: 2020-11-05 Impact factor: 5.469