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Developing a Simple Score for Diagnosis of Acute Cholecystitis at the Emergency Department. Diagnostics (Basel) 2022; 12:diagnostics12092246. [PMID: 36140646 PMCID: PMC9497808 DOI: 10.3390/diagnostics12092246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 12/07/2022] Open
Abstract
We aim to develop a diagnostic score for acute cholecystitis that integrates symptoms, physical examinations, and laboratory data to help clinicians for timely detection and early treatment of this disease. We retrospectively collected data from our database from 2010 to 2020. Patients with acute abdominal pain who underwent an ultrasound or computed tomography (CT) scan at the emergency department (ED) were included. Cases were identified by pathological, CT, or ultrasound reports. Non-cases were those who did not fulfill any of these criteria. Multivariable regression analysis was conducted to identify predictors of acute cholecystitis. The model included 244 patients suspected of acute cholecystitis. Eighty-six patients (35.2%) were acute cholecystitis confirmed cases. Five final predictors remained within the reduced logistic model: age < 60, nausea and/or vomiting, right upper quadrant pain, positive Murphy’s sign, and AST ≥ two times upper limit of normal. A practical score diagnostic performance was AuROC 0.74 (95% CI, 0.67−0.81). Patients were categorized with a high probability of acute cholecystitis at score points of 9−12 with a positive likelihood ratio of 3.79 (95% CI, 1.68−8.94). ED Chole Score from these five predictors may aid in diagnosing acute cholecystitis at ED. Patients with an ED Chole Score >8 should be further investigated.
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Uludağ SS, Akıncı O, Güreş N, Tosun Y, Şanlı AN, Zengin AK, Özçelik MF. An investigation into the predictive role of serum inflammatory parameters in the diagnosis of complicated acute cholecystitis. ULUS TRAVMA ACIL CER 2022; 28:818-823. [PMID: 35652871 PMCID: PMC10443025 DOI: 10.14744/tjtes.2021.35923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gallbladder gangrene and perforation are an important complication of acute calculous cholecystitis and are dif-ficult to detect preoperatively. Therefore, in this study, we aimed to evaluate whether serum inflammatory parameters are predictive factors for complicated cholecystitis (CC). METHODS In the present study, histopathological findings of 250 patients who were operated on with the diagnosis of acute chole-cystitis (AC) in the emergency department between 2014 and 2019 were evaluated and the cases were divided into two groups as AC and CC. Parameters, including age, gender, body mass index, white blood cell (WBC) count, C-reactive protein (CRP), neutrophil-to-lym-phocyte ratio (NLR), mean platelet volume (MPV), and platelet distribution width (PDW), were examined for their ability to predict CC. RESULTS The findings obtained in this study showed that WBC, CRP, and NLR were significantly higher in the CC group (p<0.05). WBC >9.000 cells/ml, CRP >29.0, and NLR >4.3 were the factors that could predict CC. There was no significant difference between the two groups concerning MPV and PDW (p>0.05). CC was observed more frequently in patients over 65 years of age, but there was not a statistically significant difference (p=0468). CONCLUSION WBC, CRP, and NLR are valuable biochemical markers in predicting complicated AC. Advanced age may be a help-ful predictive factor for CC. These factors may be helpful in making an early cholecystectomy decision.
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Affiliation(s)
- Server Sezgin Uludağ
- Department of General Surgery, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
| | - Ozan Akıncı
- Department of General Surgery, İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul-Turkey
| | - Nazım Güreş
- Department of General Surgery, Balıkesir Atatürk City Hospital, Balıkesir-Turkey
| | - Yasin Tosun
- Department of General Surgery, İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul-Turkey
| | - Ahmet Necati Şanlı
- Department of General Surgery, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
| | - Abdullah Kağan Zengin
- Department of General Surgery, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
| | - Mehmet Faik Özçelik
- Department of General Surgery, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul-Turkey
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OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 21:702-709. [DOI: 10.1093/eurjcn/zvac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
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Rosa F, Covino M, Cozza V, Fransvea P, Quero G, Fiorillo C, Simeoni B, Sganga G, Gasbarrini A, Franceschi F, Alfieri S. Management of acute cholecystitis in elderly patients: A propensity score-matched analysis of surgical vs. medical treatment. Dig Liver Dis 2021; 53:1620-1626. [PMID: 33500239 DOI: 10.1016/j.dld.2021.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/09/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute cholecystitis (AC) is a life-threatening emergency in elderly patients. AIMS To compare the commonly used management strategies for elderly patients with AC as well as resulting morbidity, mortality and length of hospital stay (LOS). METHODS All patients ≥ 65 years admitted to our emergency department for AC between January 1st, 2014 and December 31st, 2018 were included in the study. We compared patients that received medical treatment to patients who received operative procedures. In order to correct for baseline covariates and factors associated to clinical management, we used a 1:1 propensity score matching (PSM) analysis. The primary outcome was the overall in-hospital mortality. Secondary outcomes included occurrence of major complications and LOS. RESULTS A total of 1075 patients were enrolled: 483 patients received a medical treatment and 592 patients underwent interventional procedures. After PSM, 770 patients (385 for each treatment group) were included in the analysis. The analysis revealed that both mortality and cumulative major complications were similar in medical and interventional group. We found that among comorbidities, Charlson comorbidity index and congestive heart failure were significantly higher in the medical treatment group (5 [4-6] vs. 4 [3-6] and 11.7% vs. 4.7%, respectively; p<0.001). LOS was slightly lower in the medical treatment group (7.0 days [4.9-11.1] vs. 7.9 [4.9-13.5]; p = 0.046). CONCLUSION Medical management outcomes for AC in elderly patients were similar to operative treatments in terms of mortality and cumulative major complications. A conservative approach should always be considered.
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Affiliation(s)
- Fausto Rosa
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Cozza
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benedetta Simeoni
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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