title: Laparoscopic cholecystectomy in acute cholecystitis: C-reactive protein level combined with age predicts conversion.
abstract: BACKGROUND
  The aim was to enable prediction of risk for conversion in early laparoscopic cholecystectomy for acute cholecystitis.
  
  
  METHODS
  Multivariate analysis and receiver operating characteristic curve analysis were used to define independent predictors for conversion and optimal cutoffs. Using those, a scoring system was created to predict conversion.
  
  
  RESULTS
  In 261 patients, conversion to open cholecystectomy was necessary in 62 cases (24%). Multivariate analysis revealed age and C-reactive protein (CRP) level to be independent predictors for conversion (odds ratio 1.02; P=0.02 and odds ratio 1.01; P<0.001). Using cutoffs obtained by receiver operating characteristic curve analysis resulted in an useful scoring system to predict conversion risk (age>65 y=1+CRP value>165 mg/L=1): score 0=12%, 1=29%, 2=67% (P<0.001).
  
  
  CONCLUSIONS
  Higher age and elevated CRP level are independent predictors for conversion. Surgery for acute cholecystitis in patients with age >65 years and/or CRP level >165 mg/L should be considered as high risk for conversion.
authors.affiliation: Department of Surgery, Isala Clinics Zwolle, Zwolle, The Netherlands. k_wevers@hotmail.com
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Wevers
authors.forename: Henderik L
authors.initials: HL
authors.lastname: van Westreenen
authors.forename: Gijsbert A
authors.initials: GA
authors.lastname: Patijn
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D012372:ROC Curve; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein