Utility of liver function tests in acute cholecystitis

Abstract

Backgrounds/Aims Common bile duct stones (CBDS) affect the management of acute cholecystitis (AC). This study aims to investigate the utility of liver function tests (LFTs) in predicting the presence of CBDS in AC patients. Methods Retrospective cohort study of adult patients with AC found in the American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2016. Patients were classified into two groups, without CBDS (AC − ) and with CBDS (AC + ). LFT results namely total bilirubin, SGOT and ALP were collected and categorized into normal and abnormal with the cut-offs of 1.2 mg/dl for total bilirubin, 40 U/L for SGOT and 120 IU/L for ALP. Measures of diagnostic accuracy for individual and combinations of LFTs were computed. Results A total of 32,839 patients were included in the study, with 8,801 (26.8%) AC + and 24,038 (73.2%) AC − patients. Their mean age was 52.4 (±18.6) years and over half (59.1%) were females. Mean LFT results were significantly higher in the AC + group for total bilirubin (1.82 vs 0.97), SGOT (110.9 vs 53.3) and ALP (164.4 vs 102.3) ( p <0.0001). The proportions of abnomal LFTs were significantly higher in the AC + group for total bilirubin (47.7% vs 20.2%), SGOT (62.8% vs 27.1%) and ALP (56.6% vs 21.0%) ( p <0.0001). Among AC + , the odds of having abnormal results for bilirubin, SGOT and ALP were found to be 3.61, 4.54 and 4.90 times higher than among AC − , respectively. Conclusions Abnormal LFTs are strong predictors for the presence of CBDS in patients with AC. Normal LFTs should be interpreted with caution as some patients with AC and CBDS might not present with characteristic abnormalities in results.

Abnormal liver enzymes: A review for clinicians

“…Hemolysis is the most common cause of indirect hyperbilirubinemia followed by Gilbert’s syndrome. On the other hand, direct hyperbilirubinemia indicates liver pathology including cholestatic drug reactions, autoimmune cholestatic disease, and biliary obstruction[ 21 ].…”

“…Acute cholecystitis (AC) usually presents as a cholestatic pattern or mixed. The biochemical test abnormalities are associated with obstruction from CBD, reactive hepatitis, fatty liver, direct gallbladder pressure on the biliary tract, or portal tract inflammation[ 19 - 21 ]. Patients with calculous AC may have CBD stones in up to 15%[ 17 ].…”

“…Ahn et al [ 18 ] found GGT to be the most reliable variable for CBD stones prediction with a sensitivity of 80.6% and specificity of 75%. Another study found an elevation in ALP to be the most important predictor for CBD stones[ 21 ]. Elevated LFTs in patients with AC without CBD stones are more likely to be transient and resolve within 2-7 d after surgery[ 18 ].…”

A High Urinary Urobilinogen / Serum Total Bilirubin Ratio Reported in Abdominal Pain Patients Can Indicate Acute Hepatic Porphyria

“…However, in certain diseases, such as hemolytic anemia, hepatic jaundice, and biliary disease, the serum bilirubin level is greatly elevated and leads to the excessive production of urobilinogen. Thus, a positive result shows in the urinalysis 18,19 . However, our study demonstrated that most of the AHP patients showed normal serum bilirubin levels, consistent with the literature 9,15,20−22 .…”

A high urinary urobilinogen / serum total bilirubin ratio reported in abdominal pain patients can indicate acute hepatic porphyria

“…However, in certain diseases, such as hemolytic anemia, hepatic jaundice, and biliary disease, the serum bilirubin level is greatly elevated and leads to the excessive production of urobilinogen. Thus, a positive result shows in the urinalysis (10,11). So we believed that using serum total bilirubin for calibration could help the doctors to identify the false-positive urinary urobilinogen and furthmore suspect the diagnosis of AHP.…”