Acute Gangrenous Cholecystitis: Proposal of a Score and Comparison with Previous Published Scores

Bouassida, Mounir; Medhioub, M; Kallel, Y.; Zribi, S.; Slama, H; Mighri, Mohamed Mongi; Touinsi, Hassen

doi:10.1007/s11605-020-04707-2

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…In addition, male gender was also highly correlated with high-grade cholecystitis. This was also found by Bouassida et al and Yacoub et al in the prediction of gangrenous cholecystitis 19,20 . With just the presence of these two factors (male and gallbladder wall thickening >4 mm), we found over half of patients would have high-grade cholecystitis.…”

Section: Discussionsupporting

confidence: 88%

A novel preoperative score to predict severe acute cholecystitis

Kuhlenschmidt,

Taveras,

Schuster

et al. 2024

J Trauma Acute Care Surg

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Background In a large multicenter trial, The Parkland Grading Scale(PGS) for acute cholecystitis outperformed other grading scales and has a positive correlation with complications but is limited in its inability to preoperatively predict high-grade cholecystitis. We sought to identify preoperative variables predictive of high-grade cholecystitis(PGS 4 or 5). Methods In a six-month period, patients undergoing cholecystectomy at a single institution with prospectively graded PGS were analyzed. Stepwise logistic regression models were constructed to predict high-grade cholecystitis. The relative weight of the variables was used to derive a novel score, the Severe Acute Cholecystitis Score(SACS). This score was compared to the Emergency Surgery Acuity Score(ESS), American Association for the Surgery of Trauma(AAST) preoperative score and Tokyo Guidelines(TG) for their ability to predict high-grade cholecystitis. SACS was then validated using the database from the AAST multicenter validation of the grading scale for acute cholecystitis. Results Of the 575 patients that underwent cholecystectomy, 172(29.9%) were classified as high-grade. The stepwise logistic regression modeling identified 7 independent predictors of high-grade cholecystitis. From these variable the SACS was derived. Scores ranged from 0 to 9 points with a C statistic of 0.76, outperforming the ESS(C statistic of 0.60), AAST(0.53), and TG(0.70)(p-value <0.001). Using a cutoff of 4 or more on the SACS correctly identifies 76.2% of cases with a specificity of 91.3% and a sensitivity of 40.7%. In the multicenter database, there were 464 patients with a prospectively collected PGS. The C statistic for SACS was 0.74. Using the same cutoff of 4, SACS correctly identifies 71.6% of cases with a specificity of 83.8% and a sensitivity of 52.2%. Conclusions The Severe Acute Cholecystitis Score can preoperatively predict high-grade cholecystitis and may be useful for counseling patients and assisting in surgical decision making. Level of Evidence Prognostic Level III

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Section: Discussionsupporting

confidence: 88%

A novel preoperative score to predict severe acute cholecystitis

Kuhlenschmidt,

Taveras,

Schuster

et al. 2024

J Trauma Acute Care Surg

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“…El desarrollo de cambios secundarios en el contexto de la CA, como gangrena, inflamación xantogranulomatosa, hemorragia y enfisema, define la CA grave [21,23] . Al mismo tiempo, la CA grave o severa, se asocia con un riesgo considerable de daño a las estructuras colaterales como la arteria hepática y el árbol biliar; así como altas tasas de conversión de cirugía laparoscópica a cirugía abierta [21,24] y mayor tasa de morbilidad y mortalidad [23,24] . La colecistitis gangrenosa (CG) o gangrena vesicular, es la complicación más común de la CA [25] .…”

Section: Discussionunclassified

“…Un cálculo biliar que obstruye el conducto cístico, produce colestasis e impide el flujo de sangre de la pared vesicular como resultado de la opresión de la pared de la VB debido a una presión biliar interna elevada [26] , lo que induce isquemia y conversión a tejido necrótico [25] . La incidencia de CG en pacientes que presentan CA oscila entre el 19-40 % [21,24] , en promedio el 30 % de ellos pueden convertirse a Figura 3. Hallazgos intra-operatorios.…”

Section: Discussionunclassified

Gangrena vesicular por colecistitis hemorrágica en paciente sin factores de riesgo: reporte de un caso

Vera-Portilla

Portilla²,

Sila³

et al. 2022

Acta Med Peru

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La colecistitis hemorrágica es una complicación rara de la colecistitis aguda, pero con alta mortalidad. Clínicamente es idéntica a la colecistitis aguda, y no suele presentarse con hemorragia gastrointestinal. Presentamos el caso de un varón 57 años, sin antecedentes, ni uso de anticoagulantes, referido a nuestro hospital por una “tumoración vesicular”, tras los estudios tomográficos y de colangioresonancia, asociado a la caída de hemoglobina sérica, se define su sospecha. Ingresa a sala de operaciones y se evidencia una vesícula gangrenada, conteniendo coágulos y cálculos. Confirmando su diagnóstico con el estudio histopatológico. Debido a su similitud clínica, debe considerarse en pacientes con antecedentes de terapia anticoagulante, trauma, malignidad, o hallazgos compatibles con colecistitis alitiásica. Pero puede presentarse en pacientes sin antecedentes y estar asociado a colelitiasis. El diagnóstico temprano de esta complicación potencialmente fatal es importante para facilitar el manejo quirúrgico urgente, siendo el apoyo imagenológico, necesario para su sospecha.

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“…The new bone risk stratification was validated by calculating the area under the receiver operating characteristic (ROC) curve (AUC) using R software to compare the validities of the H/LRG and the other models ( Bouassida et al, 2021 ). The nomogram for predicting the 1-, 2-, and 3-year CRPC was developed using Cox-derived coefficients.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of a novel risk model in newly diagnosed de novo bone metastatic prostate cancer (M1b): a retrospective study

Zhang

Wang

Ding

et al. 2023

PeerJ

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Background Previous studies suggested that bone metastasis has a significant effect on the time of progression to metastatic castration-resistant prostate cancer (CRPC) for newly diagnosed de novo bone metastatic hormone-sensitive prostate cancer (mHSPC). Nevertheless, the effect of different bone metastasis sites was not fully evaluated. This study aimed to develop and validate a novel bone metastatic risk model. Methods We enrolled 122 patients who were newly diagnosed with de novo bone metastatic prostate cancer following primary androgen deprivation based therapy at our institution from January 2008 to June 2021. The metastatic bone sites were classified into six sites: skull; cervical, thoracic, and lumbar vertebrae; chest (ribs and sternum); pelvis; upper limbs; and lower limbs. We calculated the bone metastatic score (BMS) for each site: 0 points were assigned for non-metastasis and 1 point was assigned for metastasis. The X-tile was adopted to acquire optimal cutoff points of BMS. We defined high-risk group (HRG) as BMS ≥ 3 and low-risk group (LRG) as BMS < 3. The new bone risk stratification was validated by calculating the area under the receiver operating characteristic curve (AUC). Subsequently, the relevant clinical prognostic variables were added to construct a predictive nomogram for predicting CRPC. Results The median patient age was 73 years. Most patients had Gleason score ≤8 (93 cases, 76.2%). The median follow-up duration was 11.5 months (range: 2–92 months). Eighty-six patients progressed to CRPC during the follow-up. The most common bone metastatic site was the pelvis (90.2%). The median BMS was 4. Seventy-six patients had HRG, while forty-six had LRG. The 1-, 2-, and 3-year AUCs for H/LRG were 0.620, 0.754, and 0.793, respectively. The HRG was associated with earlier time to CRPC. A nomogram based on four parameters (Gleason score, H/LRG, prostate-specific antigen [PSA] nadir, and time to PSA nadir) was developed to predict CRPC. Internal validation using bootstrapping demonstrated good accuracy for predicting the CRPC (C-index: 0.727). The calibration analysis demonstrated that the model performed well. Conclusion We established a novel H/LRG risk model for newly diagnosed de novo bone metastatic prostate cancer, which provided evidence to support clinical decision-making.

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Acute Gangrenous Cholecystitis: Proposal of a Score and Comparison with Previous Published Scores

Cited by 9 publications

References 16 publications

A novel preoperative score to predict severe acute cholecystitis

A novel preoperative score to predict severe acute cholecystitis

Gangrena vesicular por colecistitis hemorrágica en paciente sin factores de riesgo: reporte de un caso

Development and validation of a novel risk model in newly diagnosed de novo bone metastatic prostate cancer (M1b): a retrospective study

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