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Prediction of the grade of acute cholecystitis by plasma level of C-reactive protein.

Kabul Gurbulak E, Gurbulak B, Akgun IE, Duzkoylu Y, Battal M, Fevzi Celayir M, Demir U - Iran Red Crescent Med J (2015)

Bottom Line: 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).Those results were found to be statistically significant (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

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.

Objectives: 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.

Patients and 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.

No MeSH data available.


Related in: MedlinePlus

The Curves Depict the Cut-Off Values of CRP Between Group I and Group II (A), and Between Group II and Group III (B)AUC, area under the curve; CI, confidence interval.
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fig18915: The Curves Depict the Cut-Off Values of CRP Between Group I and Group II (A), and Between Group II and Group III (B)AUC, area under the curve; CI, confidence interval.

Mentions: In addition, they were found to be highly correlated with the disease grade, and these correlations are statistically significant and moderately positive (P < 0.001, r = 0.743) (Table 3). After evaluating CRP levels according to the disease grade, for group II the AUC (area under the curve) was 93.8%, which was very high. LR+ (likelihood ratio) value is 268. As the area under the curve for group II is high, LR+ value is strong, the sensitivity of CRP test is 75.5%, (moderate) and the specificity is 96.6%, (strong) for determining the grade 2 acute cholecystitis. For group III, the AUC is 84.6%, which is also very high. LR+ value is 87. As the area under the curve for group III is high, LR+ value is strong, with the sensitivity of 73.9% and the specificity of 75.5%, (moderate) for determining the grade 3 acute cholecystitis (Figure 2). Those results were found to be statistically significant (P < 0.0001). Youden’s index was found to be 0.72 for group II and 0.49 for group III (Table 4). As a result, although cut-off values of CRP levels for both groups (groups II and III) have a diagnostic power; they are more meaningful for group II than group III to determine the grade of acute cholecystitis using CRP levels.


Prediction of the grade of acute cholecystitis by plasma level of C-reactive protein.

Kabul Gurbulak E, Gurbulak B, Akgun IE, Duzkoylu Y, Battal M, Fevzi Celayir M, Demir U - Iran Red Crescent Med J (2015)

The Curves Depict the Cut-Off Values of CRP Between Group I and Group II (A), and Between Group II and Group III (B)AUC, area under the curve; CI, confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4443387&req=5

fig18915: The Curves Depict the Cut-Off Values of CRP Between Group I and Group II (A), and Between Group II and Group III (B)AUC, area under the curve; CI, confidence interval.
Mentions: In addition, they were found to be highly correlated with the disease grade, and these correlations are statistically significant and moderately positive (P < 0.001, r = 0.743) (Table 3). After evaluating CRP levels according to the disease grade, for group II the AUC (area under the curve) was 93.8%, which was very high. LR+ (likelihood ratio) value is 268. As the area under the curve for group II is high, LR+ value is strong, the sensitivity of CRP test is 75.5%, (moderate) and the specificity is 96.6%, (strong) for determining the grade 2 acute cholecystitis. For group III, the AUC is 84.6%, which is also very high. LR+ value is 87. As the area under the curve for group III is high, LR+ value is strong, with the sensitivity of 73.9% and the specificity of 75.5%, (moderate) for determining the grade 3 acute cholecystitis (Figure 2). Those results were found to be statistically significant (P < 0.0001). Youden’s index was found to be 0.72 for group II and 0.49 for group III (Table 4). As a result, although cut-off values of CRP levels for both groups (groups II and III) have a diagnostic power; they are more meaningful for group II than group III to determine the grade of acute cholecystitis using CRP levels.

Bottom Line: 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).Those results were found to be statistically significant (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

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.

Objectives: 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.

Patients and 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.

No MeSH data available.


Related in: MedlinePlus