title: Predictive factors for the diagnosis of severe acute cholecystitis in an emergency setting.
abstract: BACKGROUND
  The aim of this study was to assess predictive factors for the diagnosis of severe acute cholecystitis.
  
  
  METHODS
  The medical records of 295 patients with pathologically confirmed acute cholecystitis were reviewed. Patients were divided, based on pathology findings, into a group with nonsevere acute cholecystitis and a group with severe acute cholecystitis. Preoperative data were compared by univariate and multivariate analyses. Therefore, diagnostic values were assessed based on the statistically significant predictive factors. The same approach was attempted for differential diagnosis between gangrenous and phlegmonous cholecystitis.
  
  
  RESULTS
  Among ten variables found to be significantly different at univariate analysis, four were found to be independent predictive factors of severe acute cholecystitis: fever, distension of the gallbladder, wall edema, and preoperative adverse events. Common bile duct stones were confirmed as a protective factor. Leukocyte count, cardiovascular diseases, age, gender, and diabetes were not found to be significant predictive factors of severe acute cholecystitis. No differences were found in any of the preoperative data by comparing phlegmonous and gangrenous cholecystitis.
  
  
  CONCLUSIONS
  Severe acute cholecystitis may be differentiated preoperatively from nonsevere acute cholecystitis based on clinical and US data, and predictive diagnostic values may be estimated according to the number of observed predictive factors. No differences were found when comparing phlegmonous and gangrenous cholecystitis.
authors.affiliation: Department of Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy. gborz@libero.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Borzellino
authors.forename: Francesca
authors.initials: F
authors.lastname: Steccanella
authors.forename: William
authors.initials: W
authors.lastname: Mantovani
authors.forename: Michele
authors.initials: M
authors.lastname: Genna
mesh_terms: D000368:Aged; D041881:Cholecystitis, Acute / Q000175:diagnosis* / Q000473:pathology; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
references.citation: J Surg Res. 2006 Apr;131(2):204-8
references.pmid: 16412466
references.citation: J Hepatobiliary Pancreat Surg. 2007;14(1):91-7
references.pmid: 17252302
references.citation: Gastroenterol Res Pract. 2010;2010:901739
references.pmid: 20631896
references.citation: Surg Endosc. 2008 Jan;22(1):8-15
references.pmid: 17704863
references.citation: Surg Endosc. 1996 Dec;10(12):1180-4
references.pmid: 8939838
references.citation: Am J Surg. 2003 Nov;186(5):481-5
references.pmid: 14599611
references.citation: J Hepatobiliary Pancreat Sci. 2012 Sep;19(5):578-85
references.pmid: 22872303
references.citation: Am J Surg. 2004 Nov;188(5):463-6
references.pmid: 15546551
references.citation: JAMA. 2003 Jan 1;289(1):80-6
references.pmid: 12503981
references.citation: J Hepatobiliary Pancreat Surg. 2007;14(1):78-82
references.pmid: 17252300
references.citation: J Hepatobiliary Pancreat Surg. 2006;13(2):155-9
references.pmid: 16547678
references.citation: Surgery. 1999 Oct;126(4):680-5; discussion 685-6
references.pmid: 10520915
references.citation: Curr Surg. 2002 Jan-Feb;59(1):51-4
references.pmid: 16093104