Ann Hepatobiliary Pancreat Surg.  2019 Aug;23(3):219-227. 10.14701/ahbps.2019.23.3.219.

Utility of liver function tests in acute cholecystitis

• Zgheib H
• Wakil C
• Shayya S
• Mailhac A
• Al-Taki M
• El Sayed M
• Tamim H

• KMID: 2456018
• DOI: http://doi.org/10.14701/ahbps.2019.23.3.219

Abstract

BACKGROUNDS/AIMS
Common bile duct stones (CBDS) affect the management of acute cholecystitis (AC). This study aims to investigate the utility of liver function tests (LFTs) in predicting the presence of CBDS in AC patients.
METHODS
Retrospective cohort study of adult patients with AC found in the American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2016. Patients were classified into two groups, without CBDS (AC⁻) and with CBDS (AC+). LFT results namely total bilirubin, SGOT and ALP were collected and categorized into normal and abnormal with the cut-offs of 1.2 mg/dl for total bilirubin, 40 U/L for SGOT and 120 IU/L for ALP. Measures of diagnostic accuracy for individual and combinations of LFTs were computed.
RESULTS
A total of 32,839 patients were included in the study, with 8,801 (26.8%) AC+ and 24,038 (73.2%) AC⁻ patients. Their mean age was 52.4 (±18.6) years and over half (59.1%) were females. Mean LFT results were significantly higher in the AC+ group for total bilirubin (1.82 vs 0.97), SGOT (110.9 vs 53.3) and ALP (164.4 vs 102.3) (p<0.0001). The proportions of abnomal LFTs were significantly higher in the AC+ group for total bilirubin (47.7% vs 20.2%), SGOT (62.8% vs 27.1%) and ALP (56.6% vs 21.0%) (p<0.0001). Among AC+, the odds of having abnormal results for bilirubin, SGOT and ALP were found to be 3.61, 4.54 and 4.90 times higher than among AC⁻, respectively.
CONCLUSIONS
Abnormal LFTs are strong predictors for the presence of CBDS in patients with AC. Normal LFTs should be interpreted with caution as some patients with AC and CBDS might not present with characteristic abnormalities in results.

Keyword

Acute cholecystitis; Common bile duct stone; Liver function test; Predictive value; Screening test

MeSH Terms

Adult
Aspartate Aminotransferases
Bilirubin
Cholecystitis, Acute*
Cohort Studies
Common Bile Duct
Female
Humans
Liver Function Tests*
Liver*
Quality Improvement
Retrospective Studies
Surgeons
Aspartate Aminotransferases
Bilirubin

Reference

1. Mitchell SA, Jacyna MR, Chadwick S. Common bile duct stones: a controversy revisited. Br J Surg. 1993; 80:759–760. PMID: 8330169.

2. Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002; 56(6 Suppl):S165–S169. PMID: 12447261.

3. Menezes N, Marson LP, debeaux AC, Muir IM, Auld CD. Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg. 2000; 87:1176–1181. PMID: 10971424.

4. Baron RL. Common bile duct stones: reassessment of criteria for CT diagnosis. Radiology. 1987; 162:419–424. PMID: 3797655.

5. Prat F, Meduri B, Ducot B, Chiche R, Salimbeni-Bartolini R, Pelletier G. Prediction of common bile duct stones by noninvasive tests. Ann Surg. 1999; 229:362–368. PMID: 10077048.

6. Thapa PB, Maharjan DK, Suwal B, Byanjankar B, Singh DR. Serum gamma glutamyl transferase and alkaline phosphatase in acute cholecystitis. J Nepal Health Res Counc. 2010; 8:78–81. PMID: 21876567.

7. Ahn KS, Yoon YS, Han HS, Cho JY. Use of liver function tests as first-line diagnostic tools for predicting common bile duct stones in acute cholecystitis patients. World J Surg. 2016; 40:1925–1931. PMID: 27094560.

8. Padda MS, Singh S, Tang SJ, Rockey DC. Liver test patterns in patients with acute calculous cholecystitis and/or choledocholithiasis. Aliment Pharmacol Ther. 2009; 29:1011–1018. PMID: 19210291.

9. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002; 325:639–643. PMID: 12242178.

10. Geraghty JM, Goldin RD. Liver changes associated with cholecystitis. J Clin Pathol. 1994; 47:457–460. PMID: 8027400.

11. Triger DR, MacIver AG, Gamlen TR, Wilken BJ. Liver abnormalities and gallstones: a prospective combined clinical, histological and surgical study. Br J Surg. 1976; 63:272–277. PMID: 1276658.

12. Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003; 289:80–86. PMID: 12503981.

13. Videhult P, Sandblom G, Rudberg C, Rasmussen IC. Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1171 patients undergoing cholecystectomy. HPB (Oxford). 2011; 13:519–527. PMID: 21762294.

14. Kaldor A, Akopian G, Recabaren J, Alexander M. Utility of liver function tests after laparoscopic cholecystectomy. Am Surg. 2006; 72:1238–1240. PMID: 17216828.

15. Pereira-Limâ JC, Jakobs R, Busnello JV, Benz C, Blaya C, Riemann JF. The role of serum liver enzymes in the diagnosis of choledocholithiasis. Hepatogastroenterology. 2000; 47:1522–1525. PMID: 11148992.

16. Zare M, Kargar S, Akhondi M, Mirshamsi MH. Role of liver function enzymes in diagnosis of choledocholithiasis in biliary colic patients. Acta Med Iran. 2011; 49:663–666. PMID: 22071641.

17. Parra Pérez V, Vargas Cárdenas G, Astete Benavides M, Valdivia Roldán M, Morán Tisoc L, Nuñez Calixto N, et al. [Choledocolithiasis predictors in high-risk population subjected to endoscopic retrograde pancreatocholangiography at “Hospital Nacional Arzobispo Loayza”]. Rev Gastroenterol Peru. 2007; 27:161–171. Spanish. PMID: 17712394.

18. American College of Surgeons. ACS National Surgical Quality Improvement Program. Chicago: American College of Surgeons;2011.

19. Johnston DE. Special considerations in interpreting liver function tests. Am Fam Physician. 1999; 59:2223–2230. PMID: 10221307.

20. Song SH, Kwon CI, Jin SM, Park HJ, Chung CW, Kwon SW, et al. Clinical characteristics of acute cholecystitis with elevated liver enzymes not associated with choledocholithiasis. Eur J Gastroenterol Hepatol. 2014; 26:452–457. PMID: 24518492.

21. Ahmed M. Acute cholangitis - an update. World J Gastrointest Pathophysiol. 2018; 9:1–7. PMID: 29487761.

22. Er S, Ozden S, Celik C, Yuksel BC. Can we predict severity of acute cholecystitis at admission? Pak J Med Sci. 2018; 34:1293–1296. PMID: 30344594.

23. Teefey SA, Dahiya N, Middleton WD, Bajaj S, Dahiya N, Ylagan L, et al. Acute cholecystitis: do sonographic findings and WBC count predict gangrenous changes? AJR Am J Roentgenol. 2013; 200:363–369. PMID: 23345358.

24. Habib L, Mirza MR, Ali Channa M, Wasty WH. Role of liver function tests in symptomatic cholelithiasis. J Ayub Med Coll Abbottabad. 2009; 21:117–119.

25. Fikry AA, Kassem AA, Shahin D, Shabana H. Elevated liver enzymes in patients with cholecystitis. J Surg. 2014; 2:38–41.

26. Kelly DA. Intestinal failure-associated liver disease: what do we know today? Gastroenterology. 2006; 130(2 Suppl 1):S70–S77. PMID: 16473076.

27. Thorbøll J, Vilmann P, Jacobsen B, Hassan H. Endoscopic ultrasonography in detection of cholelithiasis in patients with biliary pain and negative transabdominal ultrasonography. Scand J Gastroenterol. 2004; 39:267–269. PMID: 15074397.

28. Elta GH. Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis. World J Gastroenterol. 2008; 14:1023–1026. PMID: 18286682.

29. Petersen BT. Sphincter of Oddi dysfunction, part 2: evidencebased review of the presentations, with “objective” pancreatic findings (types I and II) and of presumptive type III. Gastrointest Endosc. 2004; 59:670–687. PMID: 15114311.

30. Petersen BT. An evidence-based review of sphincter of Oddi dysfunction: part I, presentations with “objective” biliary findings (types I and II). Gastrointest Endosc. 2004; 59:525–534. PMID: 15044889.

31. McLoughlin MT, Mitchell RM. Sphincter of Oddi dysfunction and pancreatitis. World J Gastroenterol. 2007; 13:6333–6343. PMID: 18081221.

32. Bosma PJ. Inherited disorders of bilirubin metabolism. J Hepatol. 2003; 38:107–117. PMID: 12480568.

33. Radu P, Atsmon J. Gilbert's syndrome--clinical and pharmacological implications. Isr Med Assoc J. 2001; 3:593–598. PMID: 11519385.

34. Beltrán MA. Mirizzi syndrome: history, current knowledge and proposal of a simplified classification. World J Gastroenterol. 2012; 18:4639–4650. PMID: 23002333.

35. Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P. EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc. 2008; 67:235–244. PMID: 18226685.

36. Kaltenthaler E, Vergel YB, Chilcott J, Thomas S, Blakeborough T, Walters SJ, et al. A systematic review and economic evaluation of magnetic resonance cholangiopancreatography compared with diagnostic endoscopic retrograde cholangiopancreatography. Health Technol Assess. 2004; 8:iii1–89.

37. 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 Hepatobiliary Pancreat Sci. 2018; 25:41–54. PMID: 29032636.