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Introduction:The 2018 Tokyo Guidelines are insufficient for preoperative prediction of severe acute cholecystitis (AC) preoperatively.The Parkland Grading Scale (PGS) aids in intraoperative assessment but lacks preoperative utility.Biomarkers like C-reactive protein/ albumin ratio (CAR) and systemic immune-inflammation index (SII) were explored for preoperative prediction of severe AC.The present study aimed to investigate the efficacy of biomarkers against severe AC.Methods: A retrospective analysis at the University of Health Sciences Turkey, Fatih Sultan Mehmet Training and Research Hospital covered patients undergoing early laparoscopic cholecystectomy for AC from January 2014 and January 2023.AC was defined according to the 2018 Tokyo Guidelines criteria.Patients were categorized into two groups based on the PGS for intraoperative findings: Group 1 (grades 1-3) for mild AC and group 2 (grades 4-5) for severe AC.Clinical parameters, intraoperative findings, postoperative outcomes, and biomarkers, including CAR and SII, were analyzed.Results: Of 141 patients, 93 were included in group 1 and 48 in group 2. Group 2 exhibited longer operation times, higher rates of conversion to open cholecystectomy, and complications, and prolonged hospital stays.Clinical parameters such as age, sex, symptom duration, and ASA score were varied between the groups.Biomarkers including C-reactive protein and white blood cell count differed significantly between the groups, with CAR and SII identified as predictive factors for severe AC.The cut-off points were 1.86 for CAR and 1327.69 for SII. Conclusion: Preoperative biomarkers, particularly CAR and SII, can effectively predict severe AC.Levels exceeding 1.86 for CAR and 1327.69 for SII indicate increased conversion to open cholecystectomy and postoperative complication risk.
Güneş et al. (Wed,) studied this question.