title: Prediction of the grade of acute cholecystitis by plasma level of C-reactive protein.
abstract: BACKGROUND
  Acute cholecystitis is the most common complication of gallbladder stones. Today, Tokyo guidelines criteria are recommended for diagnosis, grading, and management of acute cholecystitis.
  
  
  OBJECTIVE
  We aimed to evaluate the levels of C-reactive protein (CRP) at different cut-off values to predict the severity of the disease and its possible role in grading the disease with regard to the guideline.
  
  
  METHODS
  This is a retrospective study, analyzing 682 cases out of consecutive 892 patients with acute cholecystitis admitted to two different general surgery clinics in Istanbul, Turkey. Records of patients diagnosed with acute cholecystitis were screened retrospectively from the hospital computer database between January 2011 and July 2014. A total of 210 patients with concomitant diseases causing high CRP levels were excluded from the study. The criteria of Tokyo guidelines were used in grading the severity of acute cholecystitis, and patients were divided into 3 groups. CRP values at the time of admission were analyzed and compared among the groups.
  
  
  RESULTS
  Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001). Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001). After evaluating CRP levels according to the grade of the disease, group 2 was distinguished from group 1 with a cut-off CRP level of 70.65 mg/L, and from group 3 with a value of 198.95 mg/L. Those results were found to be statistically significant (P < 0.001).
  
  
  CONCLUSIONS
  CRP, a well-known acute phase reactant that increases rapidly in various inflammatory processes, can be accepted as a strong predictor in classifying different grades of the disease, and treatment can be reliably planned according to this classification.
authors.affiliation: Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Esin
authors.initials: E
authors.lastname: Kabul Gurbulak
authors.affiliation: Department of General Surgery, Arnavutkoy State Hospital, Istanbul, Turkey.
authors.forename: Bunyamin
authors.initials: B
authors.lastname: Gurbulak
authors.affiliation: Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ismail Ethem
authors.initials: IE
authors.lastname: Akgun
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Yigit
authors.initials: Y
authors.lastname: Duzkoylu
authors.affiliation: Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Muharrem
authors.initials: M
authors.lastname: Battal
authors.affiliation: Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Fevzi Celayir
authors.affiliation: Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Uygar
authors.initials: U
authors.lastname: Demir
keywords: Acute Cholecystitis; C Reactive Protein; Cholecystectomy