Clinical characteristics of acute cholecystitis with elevated liver enzymes not associated with choledocholithiasis.

Abstract

AIM/BACKGROUND:

Elevated liver enzymes are observed occasionally in patients with acute cholecystitis who do not have choledocholithiasis. The etiology and mechanism of this phenomenon are not well known. We aimed to compare the clinical characteristics between acute cholecystitis with and without choledocholithiasis in patients with elevated liver enzymes.

PATIENTS AND METHODS:

The medical records of acute cholecystitis patients who underwent cholecystectomy between January 2001 and October 2011 were retrospectively reviewed. We retrieved data of patients who showed abnormal liver enzymes and underwent endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, or intraoperative cholangiography.

RESULTS:

We analyzed clinical characteristics and comorbidities in 424 patients. Among 424 cholecystectomy patients with abnormal liver enzymes, 178 (42%) patients did not have choledocholithiasis and 246 (58%) patients had choledocholithiasis. The median AST, ALT, and total bilirubin were 47, 82.5 IU/dl, and 1.21 mg/dl, respectively, in patients without choledocholithiasis and 58, 96 IU/dl, and 1.53 mg/dl, respectively, in patients with choledocholithiasis. In a multivariate logistic regression analysis, fatty liver [odds ratio (OR): 0.218; P<0.001], radiologic findings (OR: 0.414; P=0.001), and the level of total bilirubin (OR: 1.410; P=0.001) were independent predictors of choledocholithiasis.

CONCLUSION:

Elevated liver enzymes in patients with cholecystitis who do not have choledocholithiasis are correlated with the presence of fatty liver and the severity of radiologic finding.

• Authors: Sang Hee Song, Chang-Il Kwon, Sun Mi Jin, Hyun Jung Park, Chul Woon Chung, Sung Won Kwon, Kwang Hyun Ko, Sung Pyo Hong
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 26 Issue 4 Pg. 452-7 (Apr 2014) ISSN: 1473-5687 [Electronic] England
• PMID: 24518492 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Biomarkers
• Aspartate Aminotransferases
• Alanine Transaminase
• Bilirubin

Topics

• Alanine Transaminase (blood)
• Aspartate Aminotransferases (blood)
• Bilirubin (blood)
• Biomarkers (blood)
• Cholangiopancreatography, Endoscopic Retrograde
• Cholangiopancreatography, Magnetic Resonance
• Cholecystectomy
• Cholecystitis, Acute (blood, diagnosis, pathology, surgery)
• Choledocholithiasis (blood, diagnosis, pathology)
• Clinical Enzyme Tests
• Comorbidity
• Fatty Liver (blood, diagnosis, pathology)
• Female
• Humans
• Liver (enzymology)
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Predictive Value of Tests
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Up-Regulation