Preoperative Predictive Value Of Plasma D-dimer For Gallbladder Gangrene In Acute Cholecystitis

Objective: To investigate the preoperative predictive value of plasma D-dimer level(D-D)for gallbladder gangrene in acute cholecystitis.Methods: A retrospective analysis was carried out including 68 cases of acute cholecystitis in the emergency department of the First Affiliated Hospital of China Medical University.All the patients suffered cholecystectomy and were divided into gangrenous cholecystitis group and non-gangrenous cholecystitis group according to the postoperative diagnosis.The univariate analysis was used to compare the indicators between two groups,including age,gender,duration from admission to operation,accompanied with gallstone or not,severe complications(perforation of gallbladder,diffused peritonitis and abscess in abdominal cavity),hospitalization stays,fever on admission,Murphy's sign,plasma D-D,WBC,red cell distribution width(RDW),platelet(PLT),creatinine(Cr),international normalized ratio(INR),direct bilirubin(DBil),lipase(LPS)and amylase(AMS)on admission.Significantly different indicators between the two groups were identified.The optimal cut-offs and area under the receiver operating characteristic curves(AUROC)of certain indicators were determined by using receiver operating characteristic curves(ROC).The sensitivity,specific,positive predictive value(PPV),negative predictive value(NPV),and the Youden index were calculated in parallel and seria1 combined analysis using the indicator with the largest AUROC and the other statistically significant ones between the two groups..Results: Among 68 cases of acute cholecystitis,28 were gangrenous cholecystitis,accounting for 41.18%.Univariate analysis showed significant differences between the two groups in D-D,WBC,INR,Cr,hospitalization stays,perforation and diffused peritonitis(P<0.05).The ROC curve suggested a AUROC above 0.7 in plasma D-D,WBC,INR and Cr.Among them,Plasma D-D had the largest AUROC of 0.892.The parallel combined analysis using D-D and WBC showed the highest sensitivity and NPV(100%,100%)and the serial combined analysis demonstrated the highest specificity and PPV(95%,90%).Conclusion: Plasma D-D level demonstrated good preoperative predictive valuefor the gallbladder gangrene in acute cholecystitis,Parallel and serial combined analysis using D-D and WBC showed the higher sensitivity and PPV.