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

Background: Acute cholecystitis is a common complication of gallbladder stones and common surgical disease. Tokyo guidelines have been introduced to standardize the diagnosis and evaluation of the disease. The guidelines include physical examination, laboratory results like C-reactive protein (CRP), white blood cell levels, and radiologic evaluation. The clinical severity of the disease is assigned to one of three grades based on these criteria. CRP levels are used as a diagnostic criterion. The 2018 Tokyo Guidelines include increased CRP levels as a criterion for diagnosis. Methods: Observational analytical prospective cohort study, conducted in General Surgery Peoples hospital, Bhopal from Nov 2022 to Feb 2024, patients visiting OPD with investigations suggesting any Gallbladder infection & inflammation S/o acute cholecystitis. Results: The study found a significant association between raised CRP levels and severe cholecystitis, with CRP levels exceeding 6 mg/L in 100% severe cases and 40% moderate cases. Additionally, ESR was significantly associated with cholecystitis grade, with all cases having raised ESR above 39 mm/hr. Conclusions: The study found that 60% of patients with acute cholecystitis had mild symptoms, with the majority being young (57.8%). The majority of cases were male, with 62.2% of mild cases being female. The study found no significant association between the grade of cholecystitis and past history of upper abdominal surgery, pancreatitis, or acute cholecystitis. However, the presence of cirrhotic liver disease was significantly associated with moderate to severe cholecystitis. Severe cholecystitis was associated with gall bladder wall thickness, CBD diameter, multiple stones, and bile spillage.