title: Clinical characteristics of acute cholecystitis with elevated liver enzymes not associated with choledocholithiasis.
abstract: OBJECTIVE
  Elevated liver enzymes are observed occasionally in patients with acute cholecystitis who do not have choledocholithiasis. The etiology and mechanism of this phenomenon are not well known. We aimed to compare the clinical characteristics between acute cholecystitis with and without choledocholithiasis in patients with elevated liver enzymes.
  
  
  METHODS
  The medical records of acute cholecystitis patients who underwent cholecystectomy between January 2001 and October 2011 were retrospectively reviewed. We retrieved data of patients who showed abnormal liver enzymes and underwent endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, or intraoperative cholangiography.
  
  
  RESULTS
  We analyzed clinical characteristics and comorbidities in 424 patients. Among 424 cholecystectomy patients with abnormal liver enzymes, 178 (42%) patients did not have choledocholithiasis and 246 (58%) patients had choledocholithiasis. The median AST, ALT, and total bilirubin were 47, 82.5 IU/dl, and 1.21 mg/dl, respectively, in patients without choledocholithiasis and 58, 96 IU/dl, and 1.53 mg/dl, respectively, in patients with choledocholithiasis. In a multivariate logistic regression analysis, fatty liver [odds ratio (OR): 0.218; P<0.001], radiologic findings (OR: 0.414; P=0.001), and the level of total bilirubin (OR: 1.410; P=0.001) were independent predictors of choledocholithiasis.
  
  
  CONCLUSIONS
  Elevated liver enzymes in patients with cholecystitis who do not have choledocholithiasis are correlated with the presence of fatty liver and the severity of radiologic finding.
authors: Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
authors: Sang Hee
authors: SH
authors: Song
authors: Chang-Il
authors: CI
authors: Kwon
authors: Sun Mi
authors: SM
authors: Jin
authors: Hyun Jung
authors: HJ
authors: Park
authors: Chul Woon
authors: CW
authors: Chung
authors: Sung Won
authors: SW
authors: Kwon
authors: Kwang Hyun
authors: KH
authors: Ko
authors: Sung Pyo
authors: SP
authors: Hong
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D042883:Choledocholithiasis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D004796:Clinical Enzyme Tests; D015897:Comorbidity; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin