Prediction of the grade of acute cholecystitis by plasma level of C-reactive protein and ESR

Kundan Rai; Kulwant Singh; Chirag Dausage

doi:10.18203/2349-2902.isj20250562

Authors

Kundan Rai Department of General Surgery People’s College of Medical Science and Research Centre, Bhopal, Madhya Pradesh, India
Kulwant Singh Department of General Surgery People’s College of Medical Science and Research Centre, Bhopal, Madhya Pradesh, India
Chirag Dausage Department of General Surgery People’s College of Medical Science and Research Centre, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20250562

Keywords:

Acute cholecystitis, CRP, ESR, Tokyo Guidelines

Abstract

Background: Acute cholecystitis is a common complication of gallbladder stones and common surgical disease. Tokyo guidelines have been introduced to standardize the diagnosis and evaluation of the disease. The guidelines include physical examination, laboratory results like C-reactive protein (CRP), white blood cell levels, and radiologic evaluation. The clinical severity of the disease is assigned to one of three grades based on these criteria. CRP levels are used as a diagnostic criterion. The 2018 Tokyo Guidelines include increased CRP levels as a criterion for diagnosis.

Methods: Observational analytical prospective cohort study, conducted in General Surgery Peoples hospital, Bhopal from Nov 2022 to Feb 2024, patients visiting OPD with investigations suggesting any Gallbladder infection & inflammation S/o acute cholecystitis.

Results: The study found a significant association between raised CRP levels and severe cholecystitis, with CRP levels exceeding 6 mg/L in 100% severe cases and 40% moderate cases. Additionally, ESR was significantly associated with cholecystitis grade, with all cases having raised ESR above 39 mm/hr.

Conclusions: The study found that 60% of patients with acute cholecystitis had mild symptoms, with the majority being young (57.8%). The majority of cases were male, with 62.2% of mild cases being female. The study found no significant association between the grade of cholecystitis and past history of upper abdominal surgery, pancreatitis, or acute cholecystitis. However, the presence of cirrhotic liver disease was significantly associated with moderate to severe cholecystitis. Severe cholecystitis was associated with gall bladder wall thickness, CBD diameter, multiple stones, and bile spillage.

Metrics

Metrics Loading ...

References

Jones MW, Genova R, O’Rourke MC. Acute cholecystitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.

Johnston DE, Kaplan MM. Pathogenesis and treatment of gallstones. N Engl J Med. 1993;328(6):412-21. DOI: https://doi.org/10.1056/NEJM199302113280608

Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepato Bil Pancreat Sci. 2018;25(1):41-54. DOI: https://doi.org/10.1002/jhbp.515

Shaffer EA. Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981-96. DOI: https://doi.org/10.1016/j.bpg.2006.05.004

Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepato Bil Pancreat Sci. 2012;19(5):578-85. DOI: https://doi.org/10.1007/s00534-012-0548-0

Sekimoto M, Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, et al. Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepato Bil Pancreat Surg. 2007;14:11-4. DOI: https://doi.org/10.1007/s00534-006-1151-z

Rajab IM, Majerczyk D, Olson ME, Addams JM, Choe ML, Nelson MS, et al. C-reactive protein in gallbladder diseases: diagnostic and therapeutic insights. Biophys Rep. 2020;6:49-67. DOI: https://doi.org/10.1007/s41048-020-00108-9

Prakash O, Parshad R. Study of determine the relationship between c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) with gall bladder adhesion on cholecystectomy. Int J Sci Res. 2021;10(6):28-30

Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepato Bil Pancreat Surg. 2007;14:78-82. DOI: https://doi.org/10.1007/s00534-006-1159-4

Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clin Investig. 1993;91(4):1351-7. DOI: https://doi.org/10.1172/JCI116336

Adamian AI, Guliaev AA, Ivanina TA, Evteeva EA, Samsonov VT. Acute phase response and plasma proteins in acute cholecystitis. Klin Lab Diagn. 1997;11:8-10.

Sekimoto M, Imanaka Y, Hirose M, Ishizaki T, Murakami G, Fukata Y. Impact of treatment policies on patient outcomes and resource utilization in acute cholecystitis in Japanese hospitals. BMC Health Serv Res. 2006;6(1):1-7. DOI: https://doi.org/10.1186/1472-6963-6-40

Aydin C, Altaca G, Berber I, Tekin K, Kara M, Titiz I. Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepato Bil Pancreat Surg. 2006;13(2):155-9. DOI: https://doi.org/10.1007/s00534-005-1042-8

Wevers KP, van Westreenen HL, Patijn GA. Laparoscopic cholecystectomy in acute cholecystitis: C-reactive protein level combined with age predicts conversion. Surg Laparosc Endosc Percut Tech. 2013;23(2):163-6. DOI: https://doi.org/10.1097/SLE.0b013e31826d7fb0

Mok KW, Reddy R, Wood F, Turner P, Ward JB, Pursnani KG, et al. Is C-reactive protein a useful adjunct in selecting patients for emergency cholecystectomy by predicting severe/gangrenous cholecystitis? Int J Surg. 2014;12(7):649-53. DOI: https://doi.org/10.1016/j.ijsu.2014.05.040

Jensen KH, Jørgensen T. Incidence of gallstones in a Danish population. Gastroenterology. 1991;100(3):790-4. DOI: https://doi.org/10.1016/0016-5085(91)80027-7

Bates T, Harrison M, Lowe D, Lawson C, Padley N. Longitudinal study of gall stone prevalence at necropsy. Gut. 1992;33(1):103-7. DOI: https://doi.org/10.1136/gut.33.1.103

Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg. 1993;165(4):399-404. DOI: https://doi.org/10.1016/S0002-9610(05)80930-4

Fialkowski E, Halpin V, Whinney RR. Acute cholecystitis. BMJ Clin Evid. 2008;2008:0411.

Schuld J, Glanemann M. Acute cholecystitis. Visc Med. 2015;31(3):163-5. DOI: https://doi.org/10.1159/000431275

Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002;325(7365):639-43. DOI: https://doi.org/10.1136/bmj.325.7365.639

Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepato Bil -Pancreat Sci. 2013;20:35-46. DOI: https://doi.org/10.1007/s00534-012-0568-9

Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M, et al. Results of the Tokyo consensus meeting Tokyo guidelines. J Hepato Bil Pancreat Surg. 2007;14(1):114-21. DOI: https://doi.org/10.1007/s00534-006-1163-8

Juvonen T, Kiviniemi H, Niemela O, Kairaluoma MI. Diagnostic accuracy of ultrasonography and C-reactive protein concentration in acute cholecystitis: a prospective clinical study. Eur J Surg. 1992;158:365-9.

Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg. 2014;57(3):162. DOI: https://doi.org/10.1503/cjs.027312