C-reactive protein measurement is not associated with an improved management of acute cholecystitis: a plié for a change.

Abstract

BACKGROUND:

The diagnosis of acute cholecystitis (AC) is challenging and may result in a delay in surgical treatment and increased mortality. The 2007 and 2013 Tokyo Guidelines for AC proposed to use C-reactive protein (CRP) as an additional bench mark of AC. The aim of this study was to evaluate whether CRP measurement influences management of patients with AC.

METHODS:

For more than a period of 5 y (May 2004 to June 2009), 1959 patients were identified from the audit of cholecystectomies in North Shore, Waitakere and Southern Cross hospitals at Waitemata District Health Board, Auckland, New Zealand. The exclusion criteria were elective and private patients, patients without AC on histologic examination of gallbladders, and patients with acute acalculous cholecystitis.

RESULTS:

A total of 414 patients met eligibility criteria. Compared with the non-CRP group, patients who had CRP measured had a longer time to operation theater and a greater proportion of acute gangrenous cholecystitis on histologic examination of excised gallbladders, but similar postoperative complication rate, index, and total hospital stay. Time to operation theater was not associated with development of acute gangrenous cholecystitis (odds ratio, 1.0; 95% confidence interval, 0.996-1.01; P = 0.797), but correlated with the index hospital admission length (correlation coefficient, 0.6092; P < 0.001).

CONCLUSIONS:

CRP measurement does not influence management of patients with AC. To improve quality of care and to minimize health care provider costs physiologically fit patients with more advanced forms of AC and higher values of CRP should have their operation performed earlier than patients with mild AC and a lower concentration of CRP.

• Authors: Andrei M Beliaev, Michael Booth
• Journal: The Journal of surgical research (J Surg Res) Vol. 198 Issue 1 Pg. 93-8 (Sep 2015) ISSN: 1095-8673 [Electronic] United States
• PMID: 26095425 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• C-Reactive Protein

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• C-Reactive Protein (analysis)
• Cholecystitis, Acute (blood, surgery)
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Retrospective Studies