Department of Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro, 8 | Stanza 2 34 39 (1C2) (Cona), 44124, Ferrara, Italy.
Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
J Gastrointest Surg. 2018 Jun;22(6):1016-1025. doi: 10.1007/s11605-018-3708-y. Epub 2018 Feb 20.
Some authors have proposed different predictive factors of severe acute cholecystitis, but generally, the results of risk analyses are expressed as odds ratios, which makes it difficult to apply in the clinical practice of the acute care surgeon. The severe form of acute cholecystitis should include both gangrenous and phlegmonous cholecystitis, due to their severe clinical course, and cholecystectomy should not be delayed. The aim of this study was to create a nomogram to obtain a graphical tool to compute the probability of having a severe acute cholecystitis.
This is a retrospective study on 393 patients who underwent emergency cholecystectomy between January 2010 and December 2015 at the Acute Care Surgery Service of the S. Anna University Hospital of Ferrara, Italy. Patients were classified as having a non-severe acute cholecystitis or a severe acute cholecystitis (i.e., gangrenous and phlegmonous) based on the final pathology report. The baseline characteristics, pre-operative signs, and abdominal ultrasound (US) findings were assessed with a stepwise multivariate logistic regression analysis to predict the risk of severe acute cholecystitis, and a nomogram was created.
Age as a continuous variable, WBC count ≥ 12.4 × 10/μl, CRP ≥9.9 mg/dl, and presence of US thickening of the gallbladder wall were significantly associated with severe acute cholecystitis at final pathology report. A significant interaction between the effect of age and CRP was found. Four risk classes were identified based on the nomogram total points.
Patients with a nomogram total point ≥ 74 should be considered at high risk of severe acute cholecystitis (at 74 total point, sensitivity = 78.5%; specificity = 78.2%; accuracy = 78.3%) and this finding could be useful for surgical planning once confirmed in a prospective study comparing the risk score stratification and clinical outcomes.
一些作者提出了不同的预测因素来诊断严重急性胆囊炎，但一般来说，风险分析的结果用比值比表示，这使得它们难以应用于急性护理外科医生的临床实践中。严重的急性胆囊炎应包括坏疽性和蜂窝织炎性胆囊炎，因为它们的临床过程严重，不应延误胆囊切除术。本研究的目的是创建一个列线图，以获得一种图形工具来计算患有严重急性胆囊炎的概率。
这是一项回顾性研究，纳入了 2010 年 1 月至 2015 年 12 月期间在意大利费拉拉圣安娜大学医院急性护理外科服务部接受急诊胆囊切除术的 393 名患者。根据最终病理报告，患者被分为患有非严重急性胆囊炎或严重急性胆囊炎（即坏疽性和蜂窝织炎性）。使用逐步多变量逻辑回归分析评估基线特征、术前体征和腹部超声（US）检查结果，以预测严重急性胆囊炎的风险，并创建一个列线图。
年龄作为连续变量、白细胞计数≥12.4×10/μl、C 反应蛋白（CRP）≥9.9mg/dl 和 US 显示胆囊壁增厚与最终病理报告中的严重急性胆囊炎显著相关。年龄和 CRP 之间的作用存在显著交互作用。根据列线图总分确定了四个风险等级。
列线图总分≥74 的患者应被认为患有严重急性胆囊炎的风险较高（总分 74 时，敏感性为 78.5%；特异性为 78.2%；准确性为 78.3%），这一发现可以在比较风险评分分层和临床结局的前瞻性研究中得到验证，有助于外科手术计划。
