C-reactive protein level as a predictor of difficult emergency laparoscopic cholecystectomy

被引:12
作者
Ng, H. J. [1 ]
Ahmed, Z. [1 ]
Khan, K. S. [1 ]
Katbeh, T. [1 ]
Nassar, A. H. M. [1 ]
机构
[1] Univ Hosp Monklands, NHS Lanarkshire, Dept Gen Surg, Airdrie ML6 0JS, Scotland
来源
BJS OPEN | 2019年 / 3卷 / 05期
关键词
ACUTE CHOLECYSTITIS; MANAGEMENT;
D O I
10.1002/bjs5.50189
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Studies focused on C-reactive protein (CRP) as a marker of difficult laparoscopic cholecystectomy are limited to small case series. The aim of this study was to evaluate the association between preoperative CRP concentration and difficulty of laparoscopic cholecystectomy in patients admitted with a biliary emergency presentation. Methods Patients with an emergency admission for biliary disease treated between 2012 and 2017 with a documented preoperative CRP level were analysed. Elective patients and those with other concurrent causes of increased CRP concentration were excluded. The intraoperative difficulty grade was based on the Nassar scale. Statistical analysis was conducted to determine the association of preoperative CRP level with difficulty grading, adjusted for the interval to surgery. Results A total of 804 emergency patients were included. The mean preoperative peak CRP level was 64 center dot 7 mg/l for operative difficulty grade I, 69 center dot 6 mg/l for grade II, 98 center dot 2 mg/l for grade III, 217 center dot 5 mg/l for grade IV and 193 center dot 1 mg/l for grade V, indicating a significant association between CRP concentration and Nassar grade (P < 0 center dot 001). Receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0 center dot 78 (95 per cent c.i. 0 center dot 75 to 0 center dot 82), differentiating patients with grade I-III from those with grade IV-V operative difficulty. ROC curve analysis found a cut-off CRP value of 90 mg/l, with 71 center dot 5 per cent sensitivity and 70 center dot 5 per cent specificity in predicting operative difficulty of grade IV or V. Logistic regression analysis found preoperative peak CRP level to be predictive of Nassar grade I-III versus grade IV-V operative difficulty, also when adjusted for timing of surgery (odds ratio 5 center dot 90, 95 per cent c.i. 2 center dot 80 to 12 center dot 50). Conclusion Raised preoperative CRP levels are associated with greater operative difficulty based on Nassar scale grading.
引用
收藏
页码:641 / 645
页数:5
相关论文
共 14 条
  • [1] Arora BS, 2017, Int Surg J, V4, P1345
  • [2] C-reactive protein has a better discriminative power than white cell count in the diagnosis of acute cholecystitis
    Beliaev, Andrei M.
    Marshall, Roger J.
    Booth, Michael
    [J]. JOURNAL OF SURGICAL RESEARCH, 2015, 198 (01) : 66 - 72
  • [3] Management of acute cholecystitis in UK hospitals: time for a change
    Cameron, IC
    Chadwick, C
    Phillips, J
    Johnson, AG
    [J]. POSTGRADUATE MEDICAL JOURNAL, 2004, 80 (943) : 292 - 294
  • [4] Prediction of the Grade of Acute Cholecystitis by Plasma Level of C-Reactive Protein
    Gurbulak, Esin Kabul
    Gurbulak, Bunyamin
    Akgun, Ismail Ethem
    Duzkoylu, Yigit
    Battal, Muharrem
    Celayir, Mustafa Fevzi
    Demir, Uygar
    [J]. IRANIAN RED CRESCENT MEDICAL JOURNAL, 2015, 17 (04)
  • [5] Kaushik B, 2018, Int Surg J, V5, P2290
  • [6] Management of complicated gallstones: Results of an alternative approach to difficult cholecystectomies
    Lirici, Marco Maria
    Califano, Andrea
    [J]. MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES, 2010, 19 (05) : 304 - 315
  • [7] Mohammed AT, 2016, Ann Pak Inst Med Sci, V12, P258
  • [8] Is C-reactive protein a useful adjunct in selecting patients for emergency cholecystectomy by predicting severe/gangrenous cholecystitis?
    Mok, K. W. J.
    Reddy, R.
    Wood, F.
    Turner, P.
    Ward, J. B.
    Pursnani, K. G.
    Date, R. S.
    [J]. INTERNATIONAL JOURNAL OF SURGERY, 2014, 12 (07) : 649 - 653
  • [9] IS LAPAROSCOPIC CHOLECYSTECTOMY POSSIBLE WITHOUT VIDEO TECHNOLOGY
    NASSAR, AHM
    ASHKAR, KA
    MOHAMED, AY
    HAFIZ, AA
    [J]. MINIMALLY INVASIVE THERAPY, 1995, 4 (02): : 63 - 65
  • [10] A preoperative predictive scoring system to predict the ability to achieve the critical view of safety during laparoscopic cholecystectomy for acute cholecystitis
    Onoe, Shunsuke
    Maeda, Atsuyuki
    Takayama, Yuichi
    Fukami, Yasuyuki
    Kaneoka, Yuji
    [J]. HPB, 2017, 19 (05) : 406 - 410