Predictive factors for the diagnosis of severe acute cholecystitis in an emergency setting.

Background: The aim of this study was to assess predictive factors for the diagnosis of severe acute cholecystitis. Methods: The medical records of 295 patients with pathologically confirmed acute cholecystitis were reviewed. Patients were divided, based on pathology findings, into a group with nonsevere acute cholecystitis and a group with severe acute cholecystitis. Preoperative data were compared by univariate and multivariate analyses. Therefore, diagnostic values were assessed based on the statistically significant predictive factors. The same approach was attempted for differential diagnosis between gangrenous and phlegmonous cholecystitis. Results: Among ten variables found to be significantly different at univariate analysis, four were found to be independent predictive factors of severe acute cholecystitis: fever, distension of the gallbladder, wall edema, and preoperative adverse events. Common bile duct stones were confirmed as a protective factor. Leukocyte count, cardiovascular diseases, age, gender, and diabetes were not found to be significant predictive factors of severe acute cholecystitis. No differences were found in any of the preoperative data by comparing phlegmonous and gangrenous cholecystitis. Conclusion: Severe acute cholecystitis may be differentiated preoperatively from nonsevere acute cholecystitis based on clinical and US data, and predictive diagnostic values may be estimated according to the number of observed predictive factors. No differences were found when comparing phlegmonous and gangrenous cholecystitis.