Abstract
Objectives
Acute cholecystitis is a gallbladder inflammation, and the Tokyo Guidelines 2018 (TG18) can be used to predict its presence and severity with high sensitivity and specificity. However, TG18 grading require the collection of excessive parameters. Monocyte distribution width (MDW) is a parameter used to detect sepsis early. Therefore, we investigated the correlation between MDW and cholecystitis severity.
Methods
We conducted a retrospective study of patients with cholecystitis admitted to our hospital from November 1, 2020, to August 31, 2021. The primary outcome was severe cholecystitis analyzed as a composite of intensive care unit (ICU) admission and mortality. The secondary outcomes were length of hospital stay, ICU stay, and TG18 grade.
Results
A total of 331 patients with cholecystitis were enrolled in this study. The average MDWs for TG18 grades 1, 2, and 3 were 20.21 ± 3.99, 20.34 ± 3.68, and 25.77 ± 6.61, respectively. For patients with severe cholecystitis, the average MDW was 25.42 ± 6.83. Using the Youden J statistic, we set a cutoff MDW of 21.6. Multivariate logistic regression revealed that patients with an MDW≥21.6 had a higher risk of severe cholecystitis (odds ratio=4.94; 95 % CI, 1.71–14.21; p=0.003). The Cox model revealed that patients with an MDW≥21.6 were more likely to have a prolonged hospital stay.
Conclusions
MDW is a reliable indicator of severe cholecystitis and prolonged length of stay. Additional MDW testing and a complete blood count may provide simple information for predicting severe cholecystitis early.
Funding source: China Medical University Hospital
Award Identifier / Grant number: DMR-112-165
Acknowledgments
This manuscript was edited by Wallace Academic Editing. We thank their efforts in revising and improving the manuscript.
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Research funding: This work was supported, in part, by China Medical University Hospital under grant (DMR-112-165). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, approval of manuscript; or decision to submit manuscript for publication.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: This study was approved by the research Ethics Committee of China Medical University and Hospital (referencing number: CMUH110-REC3-106).
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Data availability: The datasets generated and analyzed in this study are not publicly available due to the nondisclosure agreement of the Institutional Review Board. The datasets are available from the corresponding author upon reasonable request.
References
1. Cox, GR, Browne, BJ. Acute cholecystitis in the emergency department. J Emerg Med 1989;7:501–11. https://doi.org/10.1016/0736-4679(89)90154-6.Search in Google Scholar PubMed
2. Yokoe, M, Takada, T, Hwang, TL, Endo, I, Akazawa, K, Miura, F, et al.. Descriptive review of acute cholecystitis: Japan-Taiwan collaborative epidemiological study. J Hepatobiliary Pancreat Sci 2017;24:319–28. https://doi.org/10.1002/jhbp.450.Search in Google Scholar PubMed
3. Wadhwa, V, Jobanputra, Y, Garg, SK, Patwardhan, S, Mehta, D, Sanaka, MR. Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterol Rep 2017;5:36–42. https://doi.org/10.1093/gastro/gow015.Search in Google Scholar PubMed PubMed Central
4. Okamoto, K, Suzuki, K, Takada, T, Strasberg, SM, Asbun, HJ, Endo, I, et al.. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2018;25:55–72. https://doi.org/10.1002/jhbp.516.Search in Google Scholar PubMed
5. Yokoe, M, Hata, J, Takada, T, Strasberg, SM, Asbun, HJ, Wakabayashi, G, et al.. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:41–54. https://doi.org/10.1002/jhbp.515.Search in Google Scholar PubMed
6. Agnello, L, Bivona, G, Vidali, M, Scazzone, C, Giglio, RV, Iacolino, G, et al.. Monocyte distribution width (MDW) as a screening tool for sepsis in the Emergency Department. Clin Chem Lab Med 2020;58:1951–7. https://doi.org/10.1515/cclm-2020-0417.Search in Google Scholar PubMed
7. Hausfater, P, Robert Boter, N, Morales Indiano, C, Cancella de Abreu, M, Marin, AM, Pernet, J, et al.. Monocyte distribution width (MDW) performance as an early sepsis indicator in the emergency department: comparison with CRP and procalcitonin in a multicenter international European prospective study. Crit Care 2021;25:227. https://doi.org/10.1186/s13054-021-03622-5.Search in Google Scholar PubMed PubMed Central
8. Crouser, ED, Parrillo, JE, Seymour, C, Angus, DC, Bicking, K, Tejidor, L, et al.. Improved early detection of sepsis in the ED with a novel monocyte distribution width biomarker. Chest 2017;152:518–26. https://doi.org/10.1016/j.chest.2017.05.039.Search in Google Scholar PubMed PubMed Central
9. Polilli, E, Sozio, F, Frattari, A, Persichitti, L, Sensi, M, Posata, R, et al.. Comparison of monocyte distribution width (MDW) and procalcitonin for early recognition of sepsis. PLoS One 2020;15:e0227300. https://doi.org/10.1371/journal.pone.0227300.Search in Google Scholar PubMed PubMed Central
10. Laínez Martínez, S, González Del Castillo, J. Usefulness of monocyte distribution width (MDW) as a sepsis biomarker. Rev Española Quimioter 2022;35(1 Suppl):2–5. https://doi.org/10.37201/req/s01.01.2022.Search in Google Scholar PubMed PubMed Central
11. Agnello, L, Vidali, M, Lo Sasso, B, Giglio, RV, Gambino, CM, Scazzone, C, et al.. Monocyte distribution width (MDW) as a screening tool for early detecting sepsis: a systematic review and meta-analysis. Clin Chem Lab Med 2022;60:786–92. https://doi.org/10.1515/cclm-2021-1331.Search in Google Scholar PubMed
12. Ligi, D, Lo Sasso, B, Giglio, RV, Maniscalco, R, DellaFranca, C, Agnello, L, et al.. Circulating histones contribute to monocyte and MDW alterations as common mediators in classical and COVID-19 sepsis. Crit Care 2022;26:260. https://doi.org/10.1186/s13054-022-04138-2.Search in Google Scholar PubMed PubMed Central
13. Menéndez-Sánchez, P, León-Salinas, C, Amo-Salas, M, Méndez-Cea, B, García-Carranza, A. Association of laboratory and radiologic parameters in the diagnosis of acute cholecystitis. Rev Gastroenterol Mexico 2019;84:449–54. https://doi.org/10.1016/j.rgmxen.2019.02.007.Search in Google Scholar
14. Raffee, L, Kuleib, S, Oteir, A, Kewan, T, Alawneh, K, Beovich, B, et al.. Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis. Postgrad Med J 2020;96:134–8. https://doi.org/10.1136/postgradmedj-2019-137095.Search in Google Scholar PubMed
15. Er, S, Ozden, S, Celik, C, Yuksel, BC. Can we predict severity of acute cholecystitis at admission? Pakistan J Med Sci 2018;34:1293–6. https://doi.org/10.12669/pjms.345.14502.Search in Google Scholar PubMed PubMed Central
16. Yuzbasioglu, Y, Duymaz, H, Tanrikulu, CS, Halhalli, HC, Koc, MO, Tandoğan, M, et al.. Role of procalcitonin in evaluation of the severity of acute cholecystitis. Eurasian J Med 2016;48:162–6. https://doi.org/10.5152/eurasianmedj.2016.0052.Search in Google Scholar PubMed PubMed Central
17. van Dijk, AH, de Reuver, PR, Tasma, TN, van Dieren, S, Hugh, TJ, Boermeester, MA. Systematic review of antibiotic treatment for acute calculous cholecystitis. Br J Surg 2016;103:797–811. https://doi.org/10.1002/bjs.10146.Search in Google Scholar PubMed
18. Abe, K, Suzuki, K, Yahagi, M, Murata, T, Sako, H, Ishii, Y. The efficacy of PTGBD for acute cholecystitis based on the Tokyo guidelines 2018. World J Surg 2019;43:2789–96. https://doi.org/10.1007/s00268-019-05117-5.Search in Google Scholar PubMed
19. Cheng, X, Cheng, P, Xu, P, Hu, P, Zhao, G, Tao, K, et al.. Safety and feasibility of prolonged versus early laparoscopic cholecystectomy for acute cholecystitis: a single-center retrospective study. Surg Endosc 2021;35:2297–305. https://doi.org/10.1007/s00464-020-07643-z.Search in Google Scholar PubMed PubMed Central
20. Serban, D, Socea, B, Balasescu, SA, Badiu, CD, Tudor, C, Dascalu, AM, et al.. Safety of laparoscopic cholecystectomy for acute cholecystitis in the elderly: a multivariate analysis of risk factors for intra and postoperative complications. Medicina 2021;57:1–16. https://doi.org/10.3390/medicina57030230.Search in Google Scholar PubMed PubMed Central
21. Seymour, CW, Liu, VX, Iwashyna, TJ, Brunkhorst, FM, Rea, TD, Scherag, A, et al.. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:762–74. https://doi.org/10.1001/jama.2016.0288.Search in Google Scholar PubMed PubMed Central
22. Auffray, C, Sieweke, MH, Geissmann, F. Blood monocytes: development, heterogeneity, and relationship with dendritic cells. Annu Rev Immunol 2009;27:669–92. https://doi.org/10.1146/annurev.immunol.021908.132557.Search in Google Scholar PubMed
23. Issekutz, AC, Issekutz, TB. Quantitation and kinetics of blood monocyte migration to acute inflammatory reactions, and IL-1 alpha, tumor necrosis factor-alpha, and IFN-gamma. J Immunol 1993;151:2105–15. https://doi.org/10.4049/jimmunol.151.4.2105.Search in Google Scholar
24. Boyette, LB, Macedo, C, Hadi, K, Elinoff, BD, Walters, JT, Ramaswami, B, et al.. Phenotype, function, and differentiation potential of human monocyte subsets. PLoS One 2017;12:e0176460. https://doi.org/10.1371/journal.pone.0176460.Search in Google Scholar PubMed PubMed Central
25. Jakubzick, CV, Randolph, GJ, Henson, PM. Monocyte differentiation and antigen-presenting functions. Nat Rev Immunol 2017;17:349–62. https://doi.org/10.1038/nri.2017.28.Search in Google Scholar PubMed
26. Crouser, ED, Parrillo, JE, Seymour, CW, Angus, DC, Bicking, K, Esguerra, VG, et al.. Monocyte distribution width: a novel indicator of sepsis-2 and sepsis-3 in high-risk emergency department patients. Crit Care Med 2019;47:1018–25. https://doi.org/10.1097/ccm.0000000000003799.Search in Google Scholar PubMed PubMed Central
27. Ligi, D, Sasso, BL, Henry, BM, Ciaccio, M, Lippi, G, Plebani, M, et al.. Deciphering the role of monocyte and monocyte distribution width (MDW) in COVID-19: an updated systematic review and meta-analysis. Clin Chem Lab Med 2023;61:960–73. https://doi.org/10.1515/cclm-2022-0936.Search in Google Scholar PubMed
28. Nikfarjam, M, Yeo, D, Perini, M, Fink, MA, Muralidharan, V, Starkey, G, et al.. Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surg 2014;84:943–8. https://doi.org/10.1111/ans.12313.Search in Google Scholar PubMed
29. Dimitrov, E, Minkov, G, Enchev, E, Halacheva, K, Yovtchev, Y. A combination of C-reactive protein and quick sequential organ failure assessment (qSOFA) score has better prognostic accuracy than qSOFA alone in patients with complicated intra-abdominal infections. Acta Chir Belg 2020;120:396–400. https://doi.org/10.1080/00015458.2019.1642579.Search in Google Scholar PubMed
30. Lledó, JB, Ibañez, JC, Mayor, LG, Juan, MB. Laparoscopic cholecystectomy and liver cirrhosis. Surg Laparosc Endosc Percutaneous Tech 2011;21:391–5. https://doi.org/10.1097/sle.0b013e31823b5096.Search in Google Scholar PubMed
31. Micić, D, Stanković, S, Lalić, N, Đukić, V, Polovina, S. Prognostic value of preoperative neutrophil-to-lymphocyte ratio for prediction of severe cholecystitis. J Med Biochem 2018;37:121–7. https://doi.org/10.1515/jomb-2017-0063.Search in Google Scholar PubMed PubMed Central
32. Wu, A, Wang, J, Han, F, Ni, Y. Correlation between shock index and severity of septic shock and its prognostic value. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2018;30:1141–5. https://doi.org/10.3760/cma.j.issn.2095-4352.2018.012.008.Search in Google Scholar PubMed
33. Tufo, A, Pisano, M, Ansaloni, L, de Reuver, P, van Laarhoven, K, Davidson, B, et al.. Risk prediction in acute calculous cholecystitis: a systematic review and meta-analysis of prognostic factors and predictive models. J Laparoendosc Adv Surg Tech 2021;31:41–53. https://doi.org/10.1089/lap.2020.0151.Search in Google Scholar PubMed
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