Use of Liver Function Tests as First-line Diagnostic Tools for Predicting Common Bile Duct Stones in Acute Cholecystitis Patients.

Abstract

Prior studies have examined the use of liver function tests (LFT) for predicting the presence of common bile duct (CBD) stones in chronic cholecystitis (CC) patients. It is currently unclear whether LFT are also useful for predicting CBD stones in patients with acute cholecystitis (AC). Of 1059 patients who visited an emergency room with gallbladder-related symptoms between March 2004 and December 2009, 854 patients were analyzed, and were divided into three groups (556 AC patients without CBD stones (AC-CBD), 98 AC patients with CBD stones (AC+CBD), and 200 CC patients without CBD stones). We compared the LFT values at admission and the changes in LFT values over time following admission among the three groups. The LFT values were significantly greater in the AC+CBD group than in the AC-CBD groups. Of all the LFT variables analyzed, γ-glutamyl transpeptidase was the most reliable variable for predicting the presence of CBD stones, with a sensitivity of 80.6% and a specificity of 75.3% at the cut-off level of 224IU/L. The elevated LFT values decreased significantly from the start of the follow-up assessment to before cholecystectomy in the AC-CBD group, but were unchanged before stone removal in the AC+CBD group. The LFT values on initial admission and the changes in LFT values over time are reliable predictors of CBD stones in patients with AC.