title: [Design of a preoperative predictive score for choledocholithiasis].
abstract: BACKGROUND
  Choledocholithiasis is the most common cause of obstructive jaundice and occurs in 5-10% of patients with cholelithiasis.
  
  
  OBJECTIVE
  To design a preoperative predictive score for choledocholithiasis.
  
  
  METHODS
  A prospective study was carried out in 556 patients admitted to our department for biliary disease. Preoperative clinical, laboratory, and ultrasound variables were compared between patients without choledocholithiasis and 65 patients with this diagnosis. A multivariate logistic analysis was performed to obtain a predictive model of choledocholithiasis, determining sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
  
  
  RESULTS
  Predictors of choledocholithiasis were the presence of a prior history of biliary disease (history of biliary colic, acute cholecystitis, choledocholithiasis or acute biliary pancreatitis) (p=0.021, OR=2.225, 95% CI: 1.130-4.381), total bilirubin values >4mg/dl (p=0.046, OR=2.403, 95% CI: 1.106-5.685), alkaline phosphatase values >150mg/dl (p=0.022 income, OR=2.631, 95%: 1.386-6.231), gamma-glutamyltransferase (GGT) values >100mg/dl (p=0.035, OR=2.10, 95% CI: 1.345-5.850), and an ultrasound finding of biliary duct >8mm (p=0.034, OR=3.063 95% CI: 1086-8649). A score superior to 5 had a specificity and PPV of 100% for detecting choledocholithiasis and a score less than 3 had a sensitivity and NPV of 100% for excluding this diagnosis.
  
  
  CONCLUSIONS
  The preoperative score can exclude or confirm the presence of choledocholithiasis and allows patients to directly benefit from laparoscopic cholecystectomy (LC) or prior endoscopic retrograde cholangiopancreatography (ERCP).
authors.affiliation: Unidad Hepatobiliopancreatica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari i Politecnic La Fe, Valencia, España. Electronic address: jbuenolledo@ono.com.
authors.forename: Jose
authors.initials: J
authors.lastname: Bueno Lledó
authors.affiliation: Unidad Hepatobiliopancreatica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari i Politecnic La Fe, Valencia, España.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Ibáñez Cirión
authors.affiliation: Unidad Hepatobiliopancreatica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari i Politecnic La Fe, Valencia, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Torregrosa Gallud
authors.affiliation: Unidad Hepatobiliopancreatica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari i Politecnic La Fe, Valencia, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: López Andújar
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000601:surgery; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: Choledocholithiasis; Cholelithiasis; Colecistectomía laparoscópica; Coledocolitiasis; Colelitiasis; Laparoscopic cholecystectomy; Predictive score; Score predictivo