Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, 00168, Rome, Italy.
Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Langenbecks Arch Surg. 2021 Nov;406(7):2375-2382. doi: 10.1007/s00423-021-02252-3. Epub 2021 Jul 2.
Acute calculous cholecystitis (AC) is a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation. In the preoperative planning, the severity of AC should be considered as well as time of onset of symptoms and patient comorbidities. The aim of the present study was to investigate the role of an early PCT assessment in the emergency department in predicting the outcomes of laparoscopic surgery for AC.
Retrospective, mono-centric study conducted in a teaching urban hospital. We evaluated all patients admitted to our ED from January 1st, 2015, to December 31st, 2019, underwent laparoscopic cholecystectomy for AC having a preoperative PCT determination in ED.
A total of 2285 patients in our ED were admitted for AC. Among them 822 patients were treated surgically, 174 had a PCT determination in ED. Median age was 63 [50-74]. Overall, 33 patients (19.0%) had major complications (MC): 32 needed an open surgery conversion, and 3 among them deceased. Multivariate analysis demonstrated that PCT, WBC, BUN, and CCI were significantly associated to MC in our cohort. When we calculated the area under the ROC curve with regard to MC, a procalcitonin value > 0.09 at admission had sensitivity = 84.8% [68.1-94.9] and specificity = 51.8% [43.2-60.3] for the occurrence of MC.
Our results, suggest that a PCT > 0.09 ng/mL at ED admission, could be associated to a poor surgical outcome in patients treated by laparoscopic surgery for AC.
急性结石性胆囊炎（AC）是一种右上腹疼痛、发热和白细胞增多的综合征，与胆囊炎症有关。在术前规划中，应考虑 AC 的严重程度、症状发作时间和患者合并症。本研究旨在探讨急诊早期降钙素原（PCT）评估在预测 AC 腹腔镜手术结局中的作用。
回顾性、单中心研究，在一所教学城市医院进行。我们评估了 2015 年 1 月 1 日至 2019 年 12 月 31 日期间因 AC 入住我院急诊科并接受腹腔镜胆囊切除术的所有患者，这些患者均在急诊科进行了术前 PCT 测定。
我院急诊科共收治 2285 例 AC 患者。其中 822 例患者接受了手术治疗，174 例患者在急诊科进行了 PCT 测定。中位年龄为 63 [50-74] 岁。总体而言，33 例（19.0%）患者发生严重并发症（MC）：32 例需要转为开放性手术，其中 3 例死亡。多变量分析表明，PCT、白细胞计数（WBC）、血尿素氮（BUN）和Charlson 合并症指数（CCI）与本队列中的 MC 显著相关。当我们计算关于 MC 的 ROC 曲线下面积时，入院时降钙素原值>0.09 ng/mL 的患者发生 MC 的敏感性为 84.8%[68.1-94.9]，特异性为 51.8%[43.2-60.3]。
我们的研究结果表明，入院时 PCT>0.09 ng/mL 可能与接受腹腔镜手术治疗的 AC 患者手术结局不良相关。
