Pericholecystic Fat Stranding as a Predictive Factor of Length of Stays of Patients with Acute Cholecystitis: A Novel Scoring Model

The 2018 Tokyo Guidelines (TG18) are used to classify the severity of acute cholecystitis (AC) but insufficient to predict the length of hospital stay (LOS). For patients with AC, clinical factors and computed tomography features, including our proposed grading system of pericholecystic fat stranding were used for predicting an LOS of ≥7 days in the logistic regression models. Our multivariable model showed age ≥ 65 years (OR: 2.56, < 0.001), C-reactive protein (CRP) ≥ 2 mg/dL (OR: 1.97, = 0.013), gamma-glutamyltransferase levels (OR: 2.460, = 0.001), TG18 grade (OR: 2.89 per grade, < 0.001), and moderate to severe pericholecystic fat stranding (OR: 2.14, = 0.012) exhibited prolonged LOS ≥ 7 days. We developed a scoring model, including TG18 grades (score of 1-3 per grade), our grading system of fat stranding (score of 1), CRP (score of 1), and gamma-glutamyltransferase (score of 1), and a cutoff of >3 had highest diagnostic performance.