Pietro Fransvea1, Marcello Covino2,3, Fausto Rosa3,4, Caterina Puccioni5, Giuseppe Quero4, Valerio Cozza5, Antonio La Greca5,3, Francesco Franceschi2,3, Sergio Alfieri3,4, Gabriele Sganga5,3. 1. Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, 00168, Rome, Italy. pietro.fransvea@gmail.com. 2. Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. 3. Università Cattolica del Sacro Cuore, Rome, Italy. 4. Digestive Surgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy. 5. Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, 00168, Rome, Italy.
Abstract
BACKGROUND: Acute calculous cholecystitis (AC) is a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation. In the preoperative planning, the severity of AC should be considered as well as time of onset of symptoms and patient comorbidities. The aim of the present study was to investigate the role of an early PCT assessment in the emergency department in predicting the outcomes of laparoscopic surgery for AC. STUDY DESIGN: Retrospective, mono-centric study conducted in a teaching urban hospital. We evaluated all patients admitted to our ED from January 1st, 2015, to December 31st, 2019, underwent laparoscopic cholecystectomy for AC having a preoperative PCT determination in ED. RESULTS: A total of 2285 patients in our ED were admitted for AC. Among them 822 patients were treated surgically, 174 had a PCT determination in ED. Median age was 63 [50-74]. Overall, 33 patients (19.0%) had major complications (MC): 32 needed an open surgery conversion, and 3 among them deceased. Multivariate analysis demonstrated that PCT, WBC, BUN, and CCI were significantly associated to MC in our cohort. When we calculated the area under the ROC curve with regard to MC, a procalcitonin value > 0.09 at admission had sensitivity = 84.8% [68.1-94.9] and specificity = 51.8% [43.2-60.3] for the occurrence of MC. CONCLUSION: Our results, suggest that a PCT > 0.09 ng/mL at ED admission, could be associated to a poor surgical outcome in patients treated by laparoscopic surgery for AC.
BACKGROUND:Acute calculous cholecystitis (AC) is a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation. In the preoperative planning, the severity of AC should be considered as well as time of onset of symptoms and patient comorbidities. The aim of the present study was to investigate the role of an early PCT assessment in the emergency department in predicting the outcomes of laparoscopic surgery for AC. STUDY DESIGN: Retrospective, mono-centric study conducted in a teaching urban hospital. We evaluated all patients admitted to our ED from January 1st, 2015, to December 31st, 2019, underwent laparoscopic cholecystectomy for AC having a preoperative PCT determination in ED. RESULTS: A total of 2285 patients in our ED were admitted for AC. Among them 822 patients were treated surgically, 174 had a PCT determination in ED. Median age was 63 [50-74]. Overall, 33 patients (19.0%) had major complications (MC): 32 needed an open surgery conversion, and 3 among them deceased. Multivariate analysis demonstrated that PCT, WBC, BUN, and CCI were significantly associated to MC in our cohort. When we calculated the area under the ROC curve with regard to MC, a procalcitonin value > 0.09 at admission had sensitivity = 84.8% [68.1-94.9] and specificity = 51.8% [43.2-60.3] for the occurrence of MC. CONCLUSION: Our results, suggest that a PCT > 0.09 ng/mL at ED admission, could be associated to a poor surgical outcome in patients treated by laparoscopic surgery for AC.
Authors: Philipp Schuetz; Yannick Wirz; Ramon Sager; Mirjam Christ-Crain; Daiana Stolz; Michael Tamm; Lila Bouadma; Charles E Luyt; Michel Wolff; Jean Chastre; Florence Tubach; Kristina B Kristoffersen; Olaf Burkhardt; Tobias Welte; Stefan Schroeder; Vandack Nobre; Long Wei; Heiner C Bucher; Neera Bhatnagar; Djillali Annane; Konrad Reinhart; Angela Branche; Pierre Damas; Maarten Nijsten; Dylan W de Lange; Rodrigo O Deliberato; Stella Ss Lima; Vera Maravić-Stojković; Alessia Verduri; Bin Cao; Yahya Shehabi; Albertus Beishuizen; Jens-Ulrik S Jensen; Caspar Corti; Jos A Van Oers; Ann R Falsey; Evelien de Jong; Carolina F Oliveira; Bianca Beghe; Matthias Briel; Beat Mueller Journal: Cochrane Database Syst Rev Date: 2017-10-12