Abstract:

Objective

To evaluate the value of procalcitonin （PCT） in predicting the severity of acute cholecystitis in elderly patients.

Methods

Clinical data of 243 elderly patients with acute cholecystitis who underwent cholecystectomy in Beijing Electric Power Hospital of State Grid Corporation of China from July 2013 to August 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，111 patients were male and 132 female，aged 60-92 years，with a median age of 68 years. According to the Tokyo Guidelines （2018），all patients were divided into acute mild and moderate cholecystitis （AMC） group and acute severe cholecystitis（ASC） group. Univariate analysis of ASC prediction was conducted by rank-sum test and Chi-square test.Multivariate analysis was performed by multivariate Logistic regression analysis. The receiver operating characteristic （ROC） curve was delineated to determine the optimal threshold values of PCT，WBC and high-sensitivity C-reactive protein （Hs-CRP）. The area under the ROC curve （AUC） was calculated.

Results

Multivariate Logistic regression analysis showed that perigallbladder or perihepatic effusion（OR=0.258，95%CI: 0.102-0.651），WBC （OR=1.262，95%CI: 1.072-1.486），Hs-CPR （OR=1.020，95%CI:1.012-1.028） and PCT （OR=0.712，5%CI: 0.559-0.906） were the independent predictive factors for ASC in elderly patients （P＜0.05）. ROC curve analysis showed that the AUC of perihepatic or perigallbladder effusion in the diagnosis of ASC in elderly patients was 0.694 （95%CI: 0.619-0.769）. The AUC of PCT，WBC and Hs-CRP in the diagnosis of ASC in elderly patients was 0.835 （95%CI: 0.784-0.886），0.875（95%CI: 0.827-0.924） and 0.876 （95%CI: 0.828-0.925），respectively. The optimal threshold values were 0.50 μg/L，10.9×10⁹/L and 66.2 mg/L，respectively. The sensitivity and specificity of PCT were 0.89 and 0.77，respectively. The AUC of these 4 parameters combined in the diagnosis of ASC in elderly patients was 0.914，higher than that of PCT，Hs-CRP，WBC and perigallbladder or perihepatic effusion alone.

Conclusions

PCT yields high diagnostic efficacy for ASC in the elderly patients. PCT combined with WBC，Hs-CPR and perigallbladder or perihepatic effusion possesses higher predictive efficacy and more reliable evaluation effect.

Key words: Aged, Pancreatitis，acute, Procalcitonin, Logistic model, ROC curve