Ulus Travma Acil Cerrahi Derg. 2024; 30(9): 657-663 | DOI: 10.14744/tjtes.2024.24189

The role of biomarkers in predicting perforated cholecystitis cases: Can the c-reactive protein albumin ratio be a guide?

Metin Yalcin¹, Mehmet Tercan², Erhan Ozyurt², Aysen Baysan^2
1Department of General Surgery, Health Sciences University Antalya Research and Training Hospital, Antalya-Türkiye
²Department of Anesthesiology and Reanimation, University of Health Science Antalya Research and Training Hospital, Antalya-Türkiye

BACKGROUND: Gallbladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. Despite advancements in imaging technology and biochemical analysis, perforations are still diagnosed intraoperatively in some cases. This situation has revealed the need for new markers in the diagnosis of perforation. In this study, we aimed to analyze the role of biomarkers in the diagnosis of perforated cholecystitis cases.
METHODS: In this retrospective study, blood samples (white blood cells (WBC), hemoglobin, platelet count, C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), urea, creatinine, glucose, amylase, lipase, aspartate ami-notransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin) were analyzed in patients who were diagnosed with acute cholecystitis in the emergency department.
RESULTS: One hundred seventy patients were divided into two groups according to the presence or absence of gallbladder perforation. Sixty-three (37.1%) patients had perforation. Transition from laparoscopy to open operation, intensive care unit admission, length of hospital stay, and mortality were higher in the perforated group compared to the non-perforated group. When we analyzed the patients according to laboratory findings, there was a difference in WBC, NLR, CRP, albumin, and CAR parameters in the perforation group. In regression analysis, CRP and CAR performed better.
CONCLUSION: Our study showed that CRP and CAR may be diagnostic biomarkers with low specificity and sensitivity in predicting GBP in patients with acute cholecystitis. This marker is a low-cost and easily accessible parameter that may help clinicians make an early diagnosis and plan appropriate treatment for this condition with high morbidity and mortality.

Keywords: Acute cholecystitis, acute gallbladder perforation; c-reactive protein; biomarker.

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Perfore kolesistit olgularýný öngörmede biyobelirteçlerin rolü: C- reaktif protein albumin oraný yol gösterici olabilir mi?

Metin Yalcin¹, Mehmet Tercan², Erhan Ozyurt², Aysen Baysan^2
1Saðlýk Bilimleri Üniversitesi Antalya Araþtýrma ve Eðitim Hastanesi, Genel Cerrahi Kliniði, Antalya, Türkiye
²Saðlýk Bilimleri Üniversitesi Antalya Araþtýrma ve Eðitim Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Antalya, Türkiye

AMAÇ: Safra kesesi perforasyonu (SKP), akut kolesistitin nadir fakat yaþamý tehdit eden bir komplikasyonudur. Ancak teknolojik görüntülemeler ve biyokimyasal analizlere raðmen bazý olgularda perforasyon tanýsý halen operasyon esnasýnda konulmaktadýr. Bu durum perforasyon tanýsýnda yeni belirteçler ihtiyacý olduðunu ortaya koymuþtur. Bu çalýþmayla perfore kolesistit olgularýnýn tanýsýnda biyobelirteçlerin rolünü analiz etmeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu retrospektif çalýþmada acil serviste akut kolesistit tanýsý konularak ameliyat edilen hastalarda çalýþýlan kan örnekleri (beyaz kan hücresi, hemoglobin, trombosit sayýmý, C-reaktif protein (CRP), albümin, CRP /Albümin oraný (CAR), nötrofil lenfosit oraný (NLR), üre, kreatinin, glukoz, amilaz, lipaz, AST, ALT, ALP, GGT, total bilirubin, direk bilirubin) analiz edildi.
BULGULAR: 170 hasta safra kesesi perforasyonu olup olmamasýna göre iki gruba ayrýldý. Hastalarýn 63'ünde (%37.1) perforasyon mevcut idi. Perforasyon tespit edilen grupta laparoskopiden açýk operasyona geçiþ, yoðun bakýma yatýþ, hastanede yatýþ süresi ve mortalite perfore olmayan gruba göre yüksekti. Hastalarý laboratuvar bulgularýna göre incelediðimizde; gruplar arasýnda beyaz kan hücresi, NLR, CRP, albümin ve CAR parametreleri açýsýndan fark tespit edilmiþtir. Regresyon analizinde ize CRP ve CAR daha iyi performans gösterdi.
SONUÇ: Çalýþmamýz CRP ve CAR’nýn akut kolesistit tanýlý hastalarda SKP’u öngörmede özgüllük ve duyarlýlýðý düþük olmasýna raðmen tanýya yardýmcý bir biyobelirteç olabileceðini göstermiþtir. Bu belirteç klinisyenlerin yüksek morbidite ve mortaliteye sahip bu tabloya erken taný koyarak uygun tedaviyi planlamalarýna yardýmcý olabilecek düþük maliyetli ve kolay ulaþýlabilen bir parametredir.

Anahtar Kelimeler: Akut kolesistit, akut safra kesesi perforasyonu; c-reaktif protein; biyobelirteç.

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