C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases
Background White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymp...
Gespeichert in:
| Veröffentlicht in: | Journal of gastrointestinal surgery 2020-12, Vol.24 (12), p.2766-2772 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2772 |
|---|---|
| container_issue | 12 |
| container_start_page | 2766 |
| container_title | Journal of gastrointestinal surgery |
| container_volume | 24 |
| creator | Bouassida, Mahdi Zribi, Slim Krimi, Bassem Laamiri, Ghazi Mroua, Bassem Slama, Helmi Mighri, Mohamed Mongi M’saddak Azzouz, Mohamed Hamzaoui, Lamine Touinsi, Hassen |
| description | Background
White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)) compared with WBC for the severity of AC, and the risk for conversion to open surgery and to determine their diagnostic cutoff levels.
Methods
This was a prospective cohort study. Over 3 years, 556 patients underwent laparoscopic cholecystectomy for AC. Patients were classified into two groups: 139 cases of advanced acute cholecystitis (AAC) (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis), and 417 cases of non-advanced acute cholecystitis (NAAC). Multiple logistic regression and receiver-operating characteristic curve analysis were employed to explore which variables (WBC, CRP, and neutrophil-to-lymphocyte ratio (NLR)) were statistically significant in predicting AAC and conversion to open surgery.
Results
On multivariable logistic regression analysis, male gender (OR = 0.4;
p
= 0.05), diabetes mellitus (OR = 7.8;
p
= 0.005), 3–4 ASA score (OR = 5.34;
p
= 0.037), body temperature (OR = 2.65;
p
= 0.014), and CRP (OR = 1.01;
p
= 0.0001) were associated independently with AAC. The value of the area under the curve (AUC) of the CRP (0.75) was higher than that of WBC (0.67) and NLR (0.62) for diagnosing AAC. CRP was the only predictive factor of conversion in multivariate analysis (OR = 1.008 [1.003–1.013]. Comparing areas under the receiver operating characteristic curves, it was the CRP that had the highest discriminative power in terms of conversion.
Conclusion
CRP is the best inflammatory marker predictive of AAC and of conversion to open surgery. We think that our results would support a multicenter—international study to confirm the findings, and if supported, CRP should be considered as a severity criterion of acute cholecystitis in the next revised version of the Guidelines of Tokyo. |
| doi_str_mv | 10.1007/s11605-019-04459-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2318748518</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2318748518</sourcerecordid><originalsourceid>FETCH-LOGICAL-c347t-277815b6ddd600fb0bb9c1f06649046b33f4c2449ecbe0bc3d03607232aec44a3</originalsourceid><addsrcrecordid>eNp9Uctu2zAQJIoGzaP9gR4KHntRunyIoo6O0EeAAAmQFuiNoMhVrdQWXZIy4D_p54aO0h5z2gV2ZhYzQ8h7BpcMoPmUGFNQV8DaCqSs20q_ImdMN6KSiqvXZYeWVbyuf56S85QeAFgDTL8hp4I1Smuuz8jfropoXR73SO9iyDhO9DrRvEZ6hSnTqzFsbfyNkeZQAOhHl-nK7-3k0NOVmzPSbh026A4pj3lM1E6edmHaY0xjmI602x1O9H6OvzAeLunq-CftcPnZhXWImd7n2R9oGGhdK9rZhOktORnsJuG753lBfnz5_L37Vt3cfr3uVjeVE7LJFW8azepeee8VwNBD37eODaCUbEGqXohBOi5li65H6J3wIBQ0XHCLTkorLsjHRXcXw5-5WDbbMTncbOyEYU6Gi5Ko1DXTBcoXqCsGUsTB7OJY0jkYBubYiFkaMaUR89SIOZI-POvP_Rb9f8q_CgpALIBUTlPJyDyEOU7F80uyj6hcl1E</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2318748518</pqid></control><display><type>article</type><title>C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Bouassida, Mahdi ; Zribi, Slim ; Krimi, Bassem ; Laamiri, Ghazi ; Mroua, Bassem ; Slama, Helmi ; Mighri, Mohamed Mongi ; M’saddak Azzouz, Mohamed ; Hamzaoui, Lamine ; Touinsi, Hassen</creator><creatorcontrib>Bouassida, Mahdi ; Zribi, Slim ; Krimi, Bassem ; Laamiri, Ghazi ; Mroua, Bassem ; Slama, Helmi ; Mighri, Mohamed Mongi ; M’saddak Azzouz, Mohamed ; Hamzaoui, Lamine ; Touinsi, Hassen</creatorcontrib><description>Background
White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)) compared with WBC for the severity of AC, and the risk for conversion to open surgery and to determine their diagnostic cutoff levels.
Methods
This was a prospective cohort study. Over 3 years, 556 patients underwent laparoscopic cholecystectomy for AC. Patients were classified into two groups: 139 cases of advanced acute cholecystitis (AAC) (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis), and 417 cases of non-advanced acute cholecystitis (NAAC). Multiple logistic regression and receiver-operating characteristic curve analysis were employed to explore which variables (WBC, CRP, and neutrophil-to-lymphocyte ratio (NLR)) were statistically significant in predicting AAC and conversion to open surgery.
Results
On multivariable logistic regression analysis, male gender (OR = 0.4;
p
= 0.05), diabetes mellitus (OR = 7.8;
p
= 0.005), 3–4 ASA score (OR = 5.34;
p
= 0.037), body temperature (OR = 2.65;
p
= 0.014), and CRP (OR = 1.01;
p
= 0.0001) were associated independently with AAC. The value of the area under the curve (AUC) of the CRP (0.75) was higher than that of WBC (0.67) and NLR (0.62) for diagnosing AAC. CRP was the only predictive factor of conversion in multivariate analysis (OR = 1.008 [1.003–1.013]. Comparing areas under the receiver operating characteristic curves, it was the CRP that had the highest discriminative power in terms of conversion.
Conclusion
CRP is the best inflammatory marker predictive of AAC and of conversion to open surgery. We think that our results would support a multicenter—international study to confirm the findings, and if supported, CRP should be considered as a severity criterion of acute cholecystitis in the next revised version of the Guidelines of Tokyo.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-019-04459-8</identifier><identifier>PMID: 31768828</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Biomarkers ; C-Reactive Protein - analysis ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute - diagnosis ; Cholecystitis, Acute - surgery ; Conversion to Open Surgery ; Gastroenterology ; Humans ; Male ; Medicine ; Medicine & Public Health ; Original Article ; Prospective Studies ; Retrospective Studies ; Surgery</subject><ispartof>Journal of gastrointestinal surgery, 2020-12, Vol.24 (12), p.2766-2772</ispartof><rights>The Society for Surgery of the Alimentary Tract 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-277815b6ddd600fb0bb9c1f06649046b33f4c2449ecbe0bc3d03607232aec44a3</citedby><cites>FETCH-LOGICAL-c347t-277815b6ddd600fb0bb9c1f06649046b33f4c2449ecbe0bc3d03607232aec44a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-019-04459-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-019-04459-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31768828$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bouassida, Mahdi</creatorcontrib><creatorcontrib>Zribi, Slim</creatorcontrib><creatorcontrib>Krimi, Bassem</creatorcontrib><creatorcontrib>Laamiri, Ghazi</creatorcontrib><creatorcontrib>Mroua, Bassem</creatorcontrib><creatorcontrib>Slama, Helmi</creatorcontrib><creatorcontrib>Mighri, Mohamed Mongi</creatorcontrib><creatorcontrib>M’saddak Azzouz, Mohamed</creatorcontrib><creatorcontrib>Hamzaoui, Lamine</creatorcontrib><creatorcontrib>Touinsi, Hassen</creatorcontrib><title>C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Background
White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)) compared with WBC for the severity of AC, and the risk for conversion to open surgery and to determine their diagnostic cutoff levels.
Methods
This was a prospective cohort study. Over 3 years, 556 patients underwent laparoscopic cholecystectomy for AC. Patients were classified into two groups: 139 cases of advanced acute cholecystitis (AAC) (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis), and 417 cases of non-advanced acute cholecystitis (NAAC). Multiple logistic regression and receiver-operating characteristic curve analysis were employed to explore which variables (WBC, CRP, and neutrophil-to-lymphocyte ratio (NLR)) were statistically significant in predicting AAC and conversion to open surgery.
Results
On multivariable logistic regression analysis, male gender (OR = 0.4;
p
= 0.05), diabetes mellitus (OR = 7.8;
p
= 0.005), 3–4 ASA score (OR = 5.34;
p
= 0.037), body temperature (OR = 2.65;
p
= 0.014), and CRP (OR = 1.01;
p
= 0.0001) were associated independently with AAC. The value of the area under the curve (AUC) of the CRP (0.75) was higher than that of WBC (0.67) and NLR (0.62) for diagnosing AAC. CRP was the only predictive factor of conversion in multivariate analysis (OR = 1.008 [1.003–1.013]. Comparing areas under the receiver operating characteristic curves, it was the CRP that had the highest discriminative power in terms of conversion.
Conclusion
CRP is the best inflammatory marker predictive of AAC and of conversion to open surgery. We think that our results would support a multicenter—international study to confirm the findings, and if supported, CRP should be considered as a severity criterion of acute cholecystitis in the next revised version of the Guidelines of Tokyo.</description><subject>Biomarkers</subject><subject>C-Reactive Protein - analysis</subject><subject>Cholecystectomy, Laparoscopic</subject><subject>Cholecystitis, Acute - diagnosis</subject><subject>Cholecystitis, Acute - surgery</subject><subject>Conversion to Open Surgery</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uctu2zAQJIoGzaP9gR4KHntRunyIoo6O0EeAAAmQFuiNoMhVrdQWXZIy4D_p54aO0h5z2gV2ZhYzQ8h7BpcMoPmUGFNQV8DaCqSs20q_ImdMN6KSiqvXZYeWVbyuf56S85QeAFgDTL8hp4I1Smuuz8jfropoXR73SO9iyDhO9DrRvEZ6hSnTqzFsbfyNkeZQAOhHl-nK7-3k0NOVmzPSbh026A4pj3lM1E6edmHaY0xjmI602x1O9H6OvzAeLunq-CftcPnZhXWImd7n2R9oGGhdK9rZhOktORnsJuG753lBfnz5_L37Vt3cfr3uVjeVE7LJFW8azepeee8VwNBD37eODaCUbEGqXohBOi5li65H6J3wIBQ0XHCLTkorLsjHRXcXw5-5WDbbMTncbOyEYU6Gi5Ko1DXTBcoXqCsGUsTB7OJY0jkYBubYiFkaMaUR89SIOZI-POvP_Rb9f8q_CgpALIBUTlPJyDyEOU7F80uyj6hcl1E</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Bouassida, Mahdi</creator><creator>Zribi, Slim</creator><creator>Krimi, Bassem</creator><creator>Laamiri, Ghazi</creator><creator>Mroua, Bassem</creator><creator>Slama, Helmi</creator><creator>Mighri, Mohamed Mongi</creator><creator>M’saddak Azzouz, Mohamed</creator><creator>Hamzaoui, Lamine</creator><creator>Touinsi, Hassen</creator><general>Springer US</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20201201</creationdate><title>C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases</title><author>Bouassida, Mahdi ; Zribi, Slim ; Krimi, Bassem ; Laamiri, Ghazi ; Mroua, Bassem ; Slama, Helmi ; Mighri, Mohamed Mongi ; M’saddak Azzouz, Mohamed ; Hamzaoui, Lamine ; Touinsi, Hassen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-277815b6ddd600fb0bb9c1f06649046b33f4c2449ecbe0bc3d03607232aec44a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Biomarkers</topic><topic>C-Reactive Protein - analysis</topic><topic>Cholecystectomy, Laparoscopic</topic><topic>Cholecystitis, Acute - diagnosis</topic><topic>Cholecystitis, Acute - surgery</topic><topic>Conversion to Open Surgery</topic><topic>Gastroenterology</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bouassida, Mahdi</creatorcontrib><creatorcontrib>Zribi, Slim</creatorcontrib><creatorcontrib>Krimi, Bassem</creatorcontrib><creatorcontrib>Laamiri, Ghazi</creatorcontrib><creatorcontrib>Mroua, Bassem</creatorcontrib><creatorcontrib>Slama, Helmi</creatorcontrib><creatorcontrib>Mighri, Mohamed Mongi</creatorcontrib><creatorcontrib>M’saddak Azzouz, Mohamed</creatorcontrib><creatorcontrib>Hamzaoui, Lamine</creatorcontrib><creatorcontrib>Touinsi, Hassen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bouassida, Mahdi</au><au>Zribi, Slim</au><au>Krimi, Bassem</au><au>Laamiri, Ghazi</au><au>Mroua, Bassem</au><au>Slama, Helmi</au><au>Mighri, Mohamed Mongi</au><au>M’saddak Azzouz, Mohamed</au><au>Hamzaoui, Lamine</au><au>Touinsi, Hassen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>24</volume><issue>12</issue><spage>2766</spage><epage>2772</epage><pages>2766-2772</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Background
White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)) compared with WBC for the severity of AC, and the risk for conversion to open surgery and to determine their diagnostic cutoff levels.
Methods
This was a prospective cohort study. Over 3 years, 556 patients underwent laparoscopic cholecystectomy for AC. Patients were classified into two groups: 139 cases of advanced acute cholecystitis (AAC) (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis), and 417 cases of non-advanced acute cholecystitis (NAAC). Multiple logistic regression and receiver-operating characteristic curve analysis were employed to explore which variables (WBC, CRP, and neutrophil-to-lymphocyte ratio (NLR)) were statistically significant in predicting AAC and conversion to open surgery.
Results
On multivariable logistic regression analysis, male gender (OR = 0.4;
p
= 0.05), diabetes mellitus (OR = 7.8;
p
= 0.005), 3–4 ASA score (OR = 5.34;
p
= 0.037), body temperature (OR = 2.65;
p
= 0.014), and CRP (OR = 1.01;
p
= 0.0001) were associated independently with AAC. The value of the area under the curve (AUC) of the CRP (0.75) was higher than that of WBC (0.67) and NLR (0.62) for diagnosing AAC. CRP was the only predictive factor of conversion in multivariate analysis (OR = 1.008 [1.003–1.013]. Comparing areas under the receiver operating characteristic curves, it was the CRP that had the highest discriminative power in terms of conversion.
Conclusion
CRP is the best inflammatory marker predictive of AAC and of conversion to open surgery. We think that our results would support a multicenter—international study to confirm the findings, and if supported, CRP should be considered as a severity criterion of acute cholecystitis in the next revised version of the Guidelines of Tokyo.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31768828</pmid><doi>10.1007/s11605-019-04459-8</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1091-255X |
| ispartof | Journal of gastrointestinal surgery, 2020-12, Vol.24 (12), p.2766-2772 |
| issn | 1091-255X 1873-4626 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2318748518 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Biomarkers C-Reactive Protein - analysis Cholecystectomy, Laparoscopic Cholecystitis, Acute - diagnosis Cholecystitis, Acute - surgery Conversion to Open Surgery Gastroenterology Humans Male Medicine Medicine & Public Health Original Article Prospective Studies Retrospective Studies Surgery |
| title | C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T10%3A48%3A53IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=C-reactive%20Protein%20Is%20the%20Best%20Biomarker%20to%20Predict%20Advanced%20Acute%20Cholecystitis%20and%20Conversion%20to%20Open%20Surgery.%20A%20Prospective%20Cohort%20Study%20of%20556%20Cases&rft.jtitle=Journal%20of%20gastrointestinal%20surgery&rft.au=Bouassida,%20Mahdi&rft.date=2020-12-01&rft.volume=24&rft.issue=12&rft.spage=2766&rft.epage=2772&rft.pages=2766-2772&rft.issn=1091-255X&rft.eissn=1873-4626&rft_id=info:doi/10.1007/s11605-019-04459-8&rft_dat=%3Cproquest_cross%3E2318748518%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2318748518&rft_id=info:pmid/31768828&rfr_iscdi=true |