Department of Surgery, Harvard Medical School, 548305Massachusetts General Hospital, Boston, MA, USA.
Am Surg. 2022 Jul;88(7):1631-1637. doi: 10.1177/0003134821998664. Epub 2021 Mar 12.
Optimal use of interventional procedures and diagnostic tests for patients with suspected choledocholithiasis depends on accurate pretest risk estimation. We sought to define sensitivity/specificity of transaminases in identifying choledocholithiasis and to incorporate them into a biochemical marker composite score that could accurately predict choledocholithiasis.
All adult patients who underwent laparoscopic cholecystectomy by our Emergency Surgery Service between 2010 and 2018 were reviewed. Admission total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) was captured. Choledocholithiasis was confirmed via intraoperative cholangiogram, endoscopic retrograde cholangiopancreatography, or magnetic resonance cholangiopancreatography. Area under receiver operating characteristic curve (AUC) or C-statistic for AST, ALT, ALP, and TB as a measure of detecting choledocholithiasis was calculated. For score development, our database was randomly dichotomized to derivation and validation cohort and a score was derived. The score was validated by calculating its C-statistic.
1089 patients were included; 210 (20.3%) had confirmed choledocholithiasis. The AUC was .78 for TB, .77 for ALP and AST, and .76 for ALT. 545 and 544 patients were included in the derivation and the validation cohort, respectively. The elements of the derived score were TB, AST, and ALP. The score ranged from 0 to 4. The AUC was .82 in the derivation and .77 in the validation cohort. The probability of choledocholithiasis increased from 8% to 89% at scores 0 to 4, respectively.
Aspartate aminotransferase predicted choledocholithiasis adequately and should be featured in choledocholithiasis screening algorithms. We developed a biochemical composite score, shown to be accurate in preoperative choledocholithiasis risk assessment in an emergency surgery setting.
对于疑似胆总管结石的患者，介入治疗和诊断检查的最佳使用取决于术前风险的准确评估。我们旨在确定转氨酶在识别胆总管结石中的敏感性/特异性，并将其纳入生物化学标志物复合评分，以准确预测胆总管结石。
回顾了 2010 年至 2018 年期间我们的急诊外科服务接受腹腔镜胆囊切除术的所有成年患者。记录入院时总胆红素（TB）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）和碱性磷酸酶（ALP）。通过术中胆管造影、内镜逆行胰胆管造影或磁共振胰胆管造影来确认胆总管结石。计算 AST、ALT、ALP 和 TB 的受试者工作特征曲线（ROC）下面积（AUC）或 C 统计量，以评估其检测胆总管结石的能力。为了开发评分，我们的数据库被随机分为推导和验证队列，并推导出一个评分。通过计算其 C 统计量来验证该评分。
共纳入 1089 例患者，210 例（20.3%）确诊为胆总管结石。TB 的 AUC 为 0.78，ALP 和 AST 的 AUC 为 0.77，ALT 的 AUC 为 0.76。推导和验证队列分别纳入 545 例和 544 例患者。推导评分的要素为 TB、AST 和 ALP。评分范围为 0 至 4。推导队列的 AUC 为 0.82，验证队列的 AUC 为 0.77。得分分别从 0 到 4 时，胆总管结石的概率从 8%增加到 89%。
天门冬氨酸氨基转移酶可充分预测胆总管结石，应在胆总管结石筛查算法中体现。我们开发了一种生化复合评分，在急诊手术环境下对术前胆总管结石风险评估具有准确性。
