Pathological gallbladder wall thickening is associated with advanced chronic liver disease and independent of serum albumin

Abstract

Purpose Increased gallbladder wall thickness (GBWT) is a common finding. Reported causes include advanced chronic liver disease (ACLD), ascites and hypalbuminemia. GBWT is a marker for the prediction of esophageal varices. It remains unclear which of these factors is the decisive driver of GBWT. We aim to investigate whether there is a predominant factor associated with the GBWT. Methods We enrolled 258 patients with ascites, hypalbuminemia and/or ACLD and 98 healthy volunteers that underwent abdominal ultrasound. Differences of mean GBWT in subgroups of patients with ACLD, ascites, and/or hypalbuminemia were analyzed. Correlation between various parameters and GBWT were calculated using multiple regression analysis. Results GBWT in patients with ACLD + ascites + hypalbuminemia (n = 59; 5.70 ± 2.05 mm) was pathologically increased compared to patients with hypalbuminemia + ascites without ACLD (n = 36; 2.14 ± 0.66 mm; p < .001) and to patients with only hypalbuminemia (n = 76; 2.02 ± 0.80 mm; p < .001). GBWT of patients with ACLD + hypalbuminemia (n = 30; 3.42 ± 1.52 mm) and with ACLD and normal albumin level were not different (n = 46; 3.10 ± 1.62 mm; p > .999). Significant correlation was seen between GBWT and ACLD (r = .53; p < .001) and ascites (r = .51; p < .001) but not albumin level (r = .04; p = .510). Conclusion We demonstrate that ACLD is predominantly associated with GBWT. In contrast to the current literature, serum albumin level appears not to be associated with pathological GBWT.

Cholelithiasis is an additional pre-pregnancy clinical risk factor for preeclampsia

“…The observation that a pre-pregnancy history of cholelithiasis is a risk factor for preeclampsia is consistent with impaired hepatobiliary function in affected pregnancies, evidenced by increased level of liver enzymes and dysregulated cholesterol homeostasis [ 7 – 9 ]. Moreover, chronic liver disease is an independent risk factor for preeclampsia [ 10 ] and this condition is predominantly associated with increased gallbladder wall thickness [ 11 ] which has been found in four studies of preeclampsia and eclampsia pregnancies; two case reports [ 12 , 13 ] and two case series [ 14 , 15 ]. The first report described two women presenting at with upper right quadrant pain, at 24 weeks gestation and postpartum, respectively; the gallbladder abnormality was found on ultrasound in each case [ 12 ].…”

Gallbladder wall thickness adversely impacts the surgical outcome

“…We noticed, as in other studies [ 22 ], that low preoperative albumin levels in the GBWT+ group could play a role in postoperative morbidity in surgical patients. On the contrary, some studies found no correlation between wall thickness and albumin level [ 23 , 24 ]. The GBWT+ group had a higher tendency to bleed intraoperatively.…”

Associations of gallbladder and gallstone parameters with clinical outcomes in patients with cirrhosis

“…[ 7 , 8 ] In liver cirrhosis, cholecystic venous outflow tract can be impaired due to increased portal venous pressure, resulting in gallbladder congestion manifesting as changes in gallbladder length and width and gallbladder wall thickness in the axial images. [ 9 , 10 ] On the other hand, gallbladder motility may be reduced due to portal hypertension in liver cirrhosis. [ 11 ] Consequently, liver cirrhosis is associated with a high risk of gallstones, and the prevalence of gallstones is twice higher in patients with liver cirrhosis than in the general population.…”