Sistema gastrointestinal y digestivo

Abstracto

Admission CRP Level as an Indicator for the Need of Percutaneous Cholecystostomy in Acute Cholecystitis

Eran Nizri,  Lilach Epstein, Amir Ben-Yehuda, Ron Greenberg

Background: Percutaneous cholecystostomy (PC) and conservative treatment are alternatives to surgery in patients with moderate acute calculous cholecystitis. Failure or non-improvement after conservative treatment is an indication for PC.

Aim: To investigate whether C-reactive protein (CRP) level on admission is associated with percutaneous cholecystostomy (PC) in patients with acute cholecystitis.

Methods: A database of patients admitted due to acute calculous cholecystitis and treated conservatively was assembled. Diagnosis was established clinical presentation and appropriate findings in imaging studies. Patients who underwent PC at admission due to organ failure or patients operated on index admission were excluded. Overall, 161 patients were identified, of whom 106 were treated conservatively and 55 were treated with PC. Data regarding the clinical presentation, comorbidities, physical examination and various laboratory parameters were retrieved from medical files.

Results: Patients who underwent PC were older and with higher American Society of Anesthesiologists score. The mean CRP level was higher for patients treated by PC than those treated conservatively (112.8 ± 10.6 mg/ml and 45 ± 5.3 mg/ml, respectively, p < 0.001). Mean WBC count did not differ between these two groups of patients (13.8 ± 1 K/mm3 and 12.2 ± 0.5 K/mm3, respectively, p = 0.15). Patients who underwent PC had higher frequency of acute (31% vs. 5.7%) and chronic renal failure (20% vs. 4.7%, for PC and conservative treatment, respectively).

Conclusion: Increased CRP level and renal failure are associated with the need for PC. These markers prompt early PC.