Diagnostic inflammatory markers in acute cholangitis
Andrei M Beliaev1, Michael Booth2, David Rowbotham3
1Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand.
Insights
Lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) show greater diagnostic power for acute cholangitis (AC) than white cell count (WCC). These markers can aid in AC diagnosis when WCC is normal.
Area of Science:
- Gastroenterology
- Clinical Diagnostics
- Biomarker Research
Background:
- The 2018 Tokyo guidelines for acute cholangitis (AC) utilize white cell count (WCC) for diagnosis.
- Current guidelines lack guidance for AC patients presenting with normal WCC.
- The diagnostic value of alternative inflammatory biomarkers for AC remains undetermined.
Purpose of the Study:
- To evaluate the diagnostic discriminative powers of common inflammatory markers compared to WCC for AC.
- To determine optimal diagnostic cutoff levels for these inflammatory markers in AC.
Main Methods:
- A retrospective cohort study was conducted.
- Data from 96 patients undergoing endoscopic biliary decompression were analyzed over two years.
- Thirty-four AC patients and 18 controls meeting eligibility criteria were included.
Main Results:
- Lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) demonstrated the highest discriminative powers for diagnosing AC.
- Optimal cutoff values were identified: WCC ≥ 9.6 × 10⁹/L, neutrophil count ≥ 4.9 × 10⁹/L, lymphocyte count ≤ 1.3 × 10⁹/L, NLR ≥ 5.3, albumin ≤ 30.5 g/L, and CRP ≥ 23.5 mg/L.
Conclusions:
- Lymphocyte count, NLR, and CRP possess superior diagnostic capabilities compared to WCC, albumin, and neutrophil count for AC.
- These biomarkers can serve as valuable tools in the diagnosis of acute cholangitis.
Background:
The 2018 Tokyo guidelines for acute cholangitis (AC) use white cell count (WCC) as one of the diagnostic criteria. However, the 2018 Tokyo guidelines grading does not provide guidance for AC patients with normal WCC. In this situation, other inflammatory biomarkers also can be used to diagnose AC and grade severity, but their diagnostic values are yet undetermined. The aims of this study were to evaluate the discriminative powers of common inflammatory markers compared with WCC for diagnosing AC and to determine their diagnostic cutoff levels.
Methods:
This was a retrospective cohort study. Over 2 y, 96 patients who underwent endoscopic biliary decompression were identified from the Auckland City Hospital Radiology Department database. Only patients with a confirmed diagnosis of AC were included in the study. Thirty-four patients with AC and 18 controls met eligibility criteria.
Results:
Comparing areas under the receiver operating characteristic curves, it was the lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) that had the highest discriminative powers in diagnosing AC. Values of WCC for diagnosing AC were equal to or above 9.6 × 109/L, neutrophil count equal to or exceeding 4.9 × 109/L, lymphocyte count equal to or below 1.3 × 109/L, NLR 5.3 and above, albumin equal to or below 30.5 g/L, and CRP concentration 23.5 mg/L or above.
Conclusions:
Lymphocyte count, NLR, and CRP have superior discriminative powers to WCC, albumin, and neutrophil count and can be useful in the diagnosis of AC.
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