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

Abstract

Background

Gangrenous cholecystitis (GC) is a particularly severe form of acute cholecystitis (AC) and is associated with an increased risk of postoperative morbidity and mortality. Recent reports show that surgeons are remarkably unsuccessful in diagnosing GC.

Methods

We conducted a retrospective study involving 587 patients with AC. Logistic regression analysis was used to identify independent predictive factors of GC. We assigned points for the score according to the regression coefficient. The area under the curve (AUC) was determined using receiver operating characteristic (ROC) curves. The scoring system was then prospectively validated on a second population. We validated 2 previously published scoring models.

Results

Six independent predictive factors of GC were identified: [3–]4 ASA score, temperature, duration of symptoms, WBC, male gender, and pericholecystic fluid. A predictive score of GC was established based on these independent predictive factors. Sensitivity was 81.4%; specificity was 70%. The AUC of this clinicoradiological score was 0.83. The AUC of our score was higher than that of the first published score (the AUC was 0.75 in the original report and 0.78 in the validation model using our dataset) and that of the second published score (the AUC was 0.77 in the original report and 0.72 in the validation model using our dataset).

Conclusions

The AUC of our score exceeded 0.80, indicating that this score can help in diagnosing patients with GC, and thus in prioritizing these patients for surgery or choosing the adapted technique of drainage in critically ill patients.

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References

  1. 1.

    Bouassida M, Chtourou MF, Charrada H, et al. (2017) The severity grading of acute cholecystitis following the Tokyo Guidelines is the most powerful predictive factor for conversion from laparoscopic cholecystectomy to open cholecystectomy. J Visc Surg 154:239-243.

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Shirah BH, Shirah HA, Saleem MA, et al. (2019) Predictive factors for gangrene complication in acute calculous cholecystitis. Ann Hepatobilary Pacreat Surg 23:228-233.

    Article  Google Scholar 

  3. 3.

    Wu B, Buddensick TJ, Ferdosi H, et al. (2014) Predicting gangrenous cholecystitis. HPB (Oxford) 16:801-806.

    Article  Google Scholar 

  4. 4.

    Yacoub WN, Petrosyan M, Sehgal I, et al. (2010) Prediction of patients with acute cholecystitis requiring emergent cholecystectomy: a simple score. Gastroenterol Res pract 2010:191739.

    Article  Google Scholar 

  5. 5.

    Yokoe M, Hata J, Takada T, et al. (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis. J Hepatobilary Pancreat Sci 25:41-54.

    Article  Google Scholar 

  6. 6.

    Bouassida M, Hamzaoui L, Mroua B, et al. (2016) Should acute cholecystitis be operated in the 24 h following symptom onset? A retrospective cohort study. Int J Surg 25 :88-90.

    PubMed  Article  Google Scholar 

  7. 7.

    Bouassida M, Mroua B, Zribi S, et al. (2016) Usefulness of laparoscopy in gangrenous cholecystitis. Surg Laparosc Endosc Percutan Tech 26:90-92.

    PubMed  Article  Google Scholar 

  8. 8.

    Fagan SP, Awad SS, Rahwan K, et al. (2003) Prognostic factors for the development of gangrenous cholecystitis. Am J Surg 186:48-485.

    Article  Google Scholar 

  9. 9.

    Aydin C, Altaca G, Berber I, et al. (2006) Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobilary Pancreat Surg 13:155-159.

    Article  Google Scholar 

  10. 10.

    Bouassida M, Feidi B, Charrada H, et al. (2016) Could the Tokyo guidelines on the management of acute cholecystitis be adopted in developing countries? Experience of one center. Surg Today 46 :557-560.

    PubMed  Article  Google Scholar 

  11. 11.

    Nikfarjam M, Niumsawatt V, Sethu A, et al. (2011) Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford) 13:551-558.

    Article  Google Scholar 

  12. 12.

    Merriam LT, Kanaan SA, Dawes LG, et al. (1999) Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 126:480–485.

    Article  Google Scholar 

  13. 13.

    Falor AE, Zobel M, Kaji A et al. (2012) Admission variables predictive of gangrenous cholecystitis. Am Surg 78:1075–1078.

    PubMed  Google Scholar 

  14. 14.

    Salameh H, DiMaio CJ (2019) Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided gallbladder drainage. Gastrointest Endosc Clin N Am 29:293–310.

    PubMed  Article  Google Scholar 

  15. 15.

    Murabayashi T, Kanno Y, Ito K, et al. (2018) Severe peritonitis after successful endoscopic ultrasound-guided gallbladder drainage for acute gangrenous cholecystitis. Endoscopy 50:642–643.

    PubMed  Article  Google Scholar 

  16. 16.

    Bouassida M, Zribi S, Krimi B, et al (2019) C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases J Gastrointest Surg(In press). DOI: https://doi.org/10.1007/s11605-019-04459-8.

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Contributions

Mahdi Bouassida, Mouna Medhioub, Yessin Kallel, and Slim Zribi did the conception and the design of the work. Helmi Slama and Mohamed Mongi Mighri did the acquisition and the analysis of the data. Hassen Touinsi revised the work critically.

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Correspondence to Mahdi Bouassida.

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The authors declare that they have no conflict of interest.

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Bouassida, M., Madhioub, M., Kallel, Y. et al. Acute Gangrenous Cholecystitis: Proposal of a Score and Comparison with Previous Published Scores. J Gastrointest Surg (2020). https://doi.org/10.1007/s11605-020-04707-2

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Keywords

  • Acute cholecystitis
  • Gangrenous cholecystitis
  • Score