How do inflammatory marker dynamics shift with acute calculous cholecystitis severity?

Introduction: Gallstone may cause complications of cholecystitis, gallbladder gangrene, perforation, and related sepsis. This study aims to identify how CRP and immune cells change in patients with acute calculous cholecystitis based on the severity of disease.

Method: Patients with acute calculous cholecystitis were categorized into three main groups-mild, moderate, and severe-based on the Tokyo guidelines. CRP, neutrophil, lymphocyte, helper T cells, cytotoxic T lymphocytes, and HLA-DR expression on CD14+ monocytes were measured using flow cytometry at the time of hospitalization from all patients and whether there were any differences between the groups was evaluated.

Results: There were no significant differences in lymphocyte count, CD3+, CD4+, CD8+ cells, or CD4+/CD8+ ratios between groups. Though not significantly, lymphocyte count and CD3+ cells tended to decrease, while the CD4/CD8 ratio increased with disease severity. However, neutrophil count, Neutrophil/ Lymphocyte Ratio (NLR), CRP, and HLA-DR expression on CD14+ monocytes significantly increased with cholecystitis severity. The HLA-DR has 66.7% sensitivity and 92.9% specificity, while the CRP 78.6% sensitivity and 81.00% specificity and NLR 85.7% sensitivity and 76.2% specificity for predicting severe cholecystitis.

Conclusion: Evaluation of CRP, NLR, lymphocyte count, total CD3+ cells, CD4/CD8 ratio and HLA-DR expression on monocytes, at hospital admission, can provide clinicians with valuable information about the prognosis of the disease.