Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis

Abstract

BackgroundAcute cholecystitis is an emergency condition. If not promptly diagnosed and properly managed, the complication of gangrenous cholecystitis may develop, which may be a life-threatening complication.ObjectivesThe study aims to examine various characteristics and physiological parameters in patients diagnosed with acute cholecystitis to evaluate if significant predictive factors exist for the differential diagnosis of gangrenous cholecystitis.Materials and methodsThis was a retrospective study included patients with acute cholecystitis diagnosis, who presented to ‘blinded for peer review’ from 1 January 2010 to 1 January 2017. Parameters evaluated included liver function tests, complete cell count, C reactive protein, erythrocyte sedimentation rate (ESR), amylase and lipase levels, as well as medical history, and presenting clinical signs. Cases were divided according to whether or not there was a histopathological diagnosis of gangrenous cholecystitis.ResultsA total of 186 (54.5%) female and 155 (45.5%) male cases were examined. Patients with gangrenous cholecystitis tended to be male, showed a significantly higher white cell count, higher neutrophil percentage, lower lymphocyte percentage and higher ESR compared with patients without gangrenous cholecystitis. However, serum amylase and lipase demonstrated no differential diagnostic utilityConclusionMale patients with a high ESR level, high total leucocyte count with a relative high proportion of neutrophils and a low proportion of lymphocytes were found to be at increased risk of the presence of gangrenous cholecystitis.

Plasma Procalcitonin Is Useful for Predicting the Severity of Acute Cholecystitis

“…When we examine the relationship between the clinical grade and WBC count, the mean was measured 10550/mm in grade 1, 12900/mm in grade 2, and 11280/mm in grade 3. In addition to severe acute cholecystitis [11] and gangrenous cholecystitis [12], leukocyte counts were also found higher in the elderly than young patients [13]. Unlike stated in the literature, the mean WBC count of the patients included in our study was found lower.…”

The Use of Systemic Inflammatory Response Syndrome (SIRS) and Elevated Liver Enzymes as Predictive Factors of Gangrenous Cholecystitis: A Case Report

“…Additionally, an elevation of liver enzymes may signify the extension of the inflammatory process from the gallbladder wall to the liver causing hepatic parenchyma necrosis [17]. Lastly, a possible explanation of SIRS may be due to an increase in macrophage infiltration secondary to gangrenous changes leading to a release of proinflammatory cytokines and thus promoting the activation of the immune cascade in the absence of infection [18].…”

“…Doing so may ultimately lead to a better postoperative outcome. It has been shown that laparoscopic cholecystectomy may be used in patients with GC with a high rate of success without evidence of increased morbidity and mortality [18]. However, in certain circumstances, a laparoscopic approach may be difficult to perform due to an obstructed view.…”

Factores predictivos de colecistitis gangrenosa

“…Una de las principales complicaciones de la colecistitis aguda está significada en la colecistitis gangrenosa, cuadro clínico que puede ser potencialmente mortal (Raffee et al, 2020). Se ha documentado que en la colecistitis gangrenosa "la necrosis de la pared vesicular desemboca en la perforación de la pared, el absceso perivesicular o la peritonitis biliar" (Real et al, 2019, p. 444).…”