title: A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts.
abstract: BACKGROUND
  Hepatic hydatid cysts are common disorders in Turkey. Although most patients are treated by percutaneous drainage, some cases require operative intervention. Biliary fistula is a major complication of hydatid cyst operations. The purpose of this study is to identify preoperative predictors of cystobiliary fistula (CBF) and to develop a scoring system for this disorder.
  
  
  METHODS
  Overall, 135 patients with hepatic hydatid cysts were included in this study. The following variables were analyzed as potential predictors of CBF: Age, gender, findings on physical examination, complete blood cell count, liver function tests, and ultrasonographic features of the cysts (type, diameter, number, and localization).
  
  
  RESULTS
  CBF was detected in 33 of 135 patients. Univariate analyses showed significant differences in cyst diameter, levels of alkaline phosphatase (ALP) and direct bilirubin, platelet count, and white blood cell (WBC) count between patients with and without CBF. On multivariate analyses, WBC count > 9,000/mm(3) (odds ratio [OR], 4.5), direct bilirubin level > 0.7 mg/dL (OR, 2.76), cyst diameter > 8.2 cm (OR, 5.48), and ALP level > 120 U/L (OR, 3.82) were significant and independent predictors of CBG. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.803 (95% confidence interval, 0.726-0.866).
  
  
  CONCLUSIONS
  Preoperative detection and management of CBF are important issues in the treatment of hydatid cysts of the liver. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with hepatic hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice.
authors.affiliation: Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: Bariş
authors.initials: B
authors.lastname: Saylam
authors.forename: Faruk
authors.initials: F
authors.lastname: Coşkun
authors.forename: Bariş
authors.initials: B
authors.lastname: Demiriz
authors.forename: Veli
authors.initials: V
authors.lastname: Vural
authors.forename: Bülent
authors.initials: B
authors.lastname: Comçali
authors.forename: Mesut
authors.initials: M
authors.lastname: Tez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001658:Biliary Fistula / Q000175:diagnosis* / Q000209:etiology; D003661:Decision Support Techniques; D004444:Echinococcosis, Hepatic / Q000150:complications* / Q000601:surgery; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult