J Korean Soc Emerg Med.  2015 Aug;26(4):320-325. 10.0000/jksem.2015.26.4.320.

Prediction of Complicated Acute Cholecystitis During Emergency Department Stay

• Park HI
• Park JW
• Shim MB
• Bae JK
• Je SM
• Chung TN
• Kim EC
• Choi SW
• Kim OJ

• KMID: 2116801
• DOI: http://doi.org/10.0000/jksem.2015.26.4.320

Abstract

PURPOSE
The aim of the study was to determine the factors associated with complicated acute cholecystitis of initial clinical findings during an emergency department (ED) visit, and to use them as a guideline for consideration of early and active surgical intervention, to improve the prognosis of acute cholecystitis.
METHODS
Medical records of adult patients diagnosed and treated in the ED as acute cholecystitis were reviewed retrospectively. Clinical findings including demographic data, past medical history, symptoms, physical exam, and laboratory test results were included in the analysis. A case associated with gall bladder empyema, gangrene, perforation, hydrops, or failure of initial laparoscopic approach was defined as complicated acute cholecystitis. Factors showing significance in univariate analyses were included in binary logistic regression analysis for prediction of complicated acute cholecystitis.
RESULTS
Age, sex, hypertension history, anorexia, body temperature, white blood cell count (WBC), aspartate aminotransferase, creatinine, total bilirubin, amylase, and lipase were significant in univariate analyses, and included in multivariate analysis. Age (p=0.039), male sex (p=0.004), and WBC (p=0.019) were significant in multivariate analysis.
CONCLUSION
Age, sex, and initial WBC of patients diagnosed and treated in the ED as acute cholecystitis were independently associated with complicated acute cholecystitis.

Keyword

Acute cholecystitis; Prognosis; Complications

MeSH Terms

Adult
Amylases
Anorexia
Aspartate Aminotransferases
Bilirubin
Body Temperature
Cholecystitis
Cholecystitis, Acute*
Creatinine
Edema
Emergencies*
Emergency Service, Hospital*
Gangrene
Humans
Hypertension
Leukocyte Count
Lipase
Logistic Models
Male
Medical Records
Multivariate Analysis
Prognosis
Retrospective Studies
Amylases
Aspartate Aminotransferases
Bilirubin
Creatinine
Lipase