Chitotriosidase and Neopterin as Potential Biomarkers for the Evaluation of Complicated Cholecystitis—A Pilot Study

Abstract

Gallstones are a common surgical pathology. Laparoscopic cholecystectomy represents the elective treatment. Complicated cases can increase the rate of conversion, the duration, and the difficulty of the intervention, along with the hospitalization period. A prospective cohort study was conducted on 51 patients with gallstones. Only subjects with normal renal, pancreatic, and hepatic functions were included. The severity of cholecystitis was evaluated by considering the ultrasound examination, intraoperative findings, and pathology report. We evaluated two potential biomarkers, namely neopterin and chitotriosidase, by comparing their levels before and after the intervention for chronic (n = 36) and complicated (n = 15) cases, as well as their eventual association with the hospitalization period. Subjects with complicated cholecystitis had significantly higher (p = 0.01) neopterin levels at presentation (16.82 nmol/L vs. 11.92 nmol/L, median values), but the differences in chitotriosidase activity between complicated (170.00 nmol/mL/h) and chronic (160.00 nmol/mL/h) cases were not significant (p = 0.66). Patients with neopterin levels above the cut-off value 14.69 nmol/L had a 3.34 times higher risk of complicated cholecystitis. Twenty-four hours after the laparoscopic cholecystectomy, the differences in neopterin level and chitotriosidase activity between chronic and complicated cases were not significant. A significant decrease in chitotriosidase activity was observed after the intervention, only for complicated cases (190 nmol/mL/h vs. 145 nmol/mL/h, p = 0.007); for neopterin, the postoperative decrease was not statistically significant (19.42 nmol/L vs. 10.92 nmol/L, p = 0.06). No significant association with the hospitalization period was observed. Neopterin may be a useful biomarker for complicated cholecystitis, and chitotriosidase may have prognostic utility in early patient follow-up.

The Significance of Preoperative Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Inflammatory Index (SII) in Predicting Severity and Adverse Outcomes in Acute Calculous Cholecystitis

“…Several studies found CRP to be a good predictive factor for conversion; however, the cut-off values varied widely from 76 mg/L to 220 mg/L [5,[10][11][12][13]. Together with the valuable findings provided by ultrasound and CT exam, specific biomarkers were analyzed for the possible predictive role for the severity of local inflammation, such as the YKL-40 protein level [14], serum level of visfatin [15], procalcitonin [16], human neutrophil lipocalin [17], chitotriosidase, and neopterin [18]. However, their availability in emergencies is limited in many surgical departments.…”

“…Recently, the systemic inflammatory biomarkers, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were investigated for their predictive value in many inflammatory and septic conditions [18][19][20][21][22], such as septic shock, diabetic foot ulcer, acute appendicitis, and spontaneous bacterial peritonitis. They are cheap and inexpensive biomarkers, easy to calculate based on the complete blood count (CBC).…”

Neopterin, the Cell-Mediated Immune Response Biomarker, in Inflammatory Periodontal Diseases: A Narrative Review of a More than Fifty Years Old Biomarker

“…For bacterial diseases, Np was proposed to predict complicated cholecystitis. A 3.34 times higher risk of complications was reported in subjects with Np levels that exceeded the cut-off limit (>14.69 nmol/L) [85]. Np is also a valuable biomarker for the diagnosis of acute appendicitis but was not able to predict the severity of the disease [86].…”