Prediction of the Grade of Acute Cholecystitis by Plasma Level of C-Reactive Protein

Abstract

Background:Acute cholecystitis is the most common complication of gallbladder stones. Today, Tokyo guidelines criteria are recommended for diagnosis, grading, and management of acute cholecystitis.Objectives:We aimed to evaluate the levels of C-reactive protein (CRP) at different cut-off values to predict the severity of the disease and its possible role in grading the disease with regard to the guideline.Patients and Methods:This is a retrospective study, analyzing 682 cases out of consecutive 892 patients with acute cholecystitis admitted to two different general surgery clinics in Istanbul, Turkey. Records of patients diagnosed with acute cholecystitis were screened retrospectively from the hospital computer database between January 2011 and July 2014. A total of 210 patients with concomitant diseases causing high CRP levels were excluded from the study. The criteria of Tokyo guidelines were used in grading the severity of acute cholecystitis, and patients were divided into 3 groups. CRP values at the time of admission were analyzed and compared among the groups.Results:Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001). Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001). After evaluating CRP levels according to the grade of the disease, group 2 was distinguished from group 1 with a cut-off CRP level of 70.65 mg/L, and from group 3 with a value of 198.95 mg/L. Those results were found to be statistically significant (P < 0.001).Conclusions:CRP, a well-known acute phase reactant that increases rapidly in various inflammatory processes, can be accepted as a strong predictor in classifying different grades of the disease, and treatment can be reliably planned according to this classification.

Epstein‐Barr virus infection with acute acalculous cholecystitis in previously healthy children

“…These findings confirmed the observation that AAC was concomitant with acute hepatitis rather than being induced by intrahepatic cholestasis . The correlation between the C‐reactive protein concentration in the blood and the severity of acute cholecytitis is a well‐known observation in adult patients, and several studies reported that the CRP value was a reliable predictor of severe conditions of inflammation and should be used in Tokyo classification . The correlation was not evaluated for the paediatric group, but it seemed similar to the observations for adults.…”

“…In the absence of reliable laboratory markers, the diagnosis of AAC is arrived at based on abdominal ultrasonography, with patients exhibiting thickening of the gallbladder wall (>3 mm), pericholecystic fluid, and mucosal membrane sludge. The combination of these ultrasonographic criteria, combined with the absence of gallstones and the elevation of C‐reactive protein as the separate biochemical marker, translated into the diagnosis of AAC in children …”

Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

“…Grade I (mild) comprises cases other than Grades II and III, with lower risk of death and surgical risk that can easily be treated by laparoscopic cholecystectomy (LC). Since the Tokyo Guidelines (TG) have become widely known worldwide, recent multidirectional studies have evaluated the TG13 severity grading criteria for AC . In Tunisia, the spread of the TG has increased the rate of LC, significantly reducing preoperative and total hospital stay without increasing intra‐ and postoperative complications ; in Taiwan, Cheng et al.…”

“…Grade I (mild) comprises cases other than Grades II and III, with lower risk of death and surgical risk that can easily be treated by laparoscopic cholecystectomy (LC). Since the Tokyo Guidelines (TG) have ORIGINAL ARTICLE become widely known worldwide, recent multidirectional studies have evaluated the TG13 severity grading criteria for AC [2][3][4][5][6][7][8][9][10][11][12]. In Tunisia, the spread of the TG has increased the rate of LC, significantly reducing preoperative and total hospital stay without increasing intra-and postoperative complications [2]; in Taiwan, Cheng et al mentioned the complication rate and the length of hospital stay increased along with the severity grade of the TG [3]; and in Japan, too, a significant correlation has been reported between severity grade and both prolonged postoperative hospital stay and medical cost [4].…”

Descriptive review of acute cholecystitis: Japan‐Taiwan collaborative epidemiological study

“…Among recent reports, studies of CRP stand out in particular. One study that addressed the association between CRP and the TG13 severity grading criteria found that a CRP level >7.065 mg/dl may be considered as Grade II with 75% sensitivity and 96.5% specificity [26]. Another study investigating the association between WBC count, CRP, and histopathological findings found that CRP has a better discriminative power than WBC count in most forms of AC and is a useful diagnostic marker of AC [27].…”