A novel preoperative score to predict severe acute cholecystitis

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Diagnostics

Background:

• The Parkland Grading Scale (PGS) for acute cholecystitis shows correlation with complications but cannot preoperatively predict high-grade disease.
• Existing grading scales have limitations in accurately identifying severe cases of acute cholecystitis before surgery.

Purpose of the Study:

• To identify preoperative variables that predict high-grade acute cholecystitis (PGS grade 4 or 5).
• To develop and validate a novel scoring system for predicting severe acute cholecystitis.

Main Methods:

• A logistic regression model was used to identify predictors of high-grade cholecystitis in 575 patients.
• The Severe Acute Cholecystitis Score (SACS) was derived from these predictors and compared to existing scores (ESS, AAST, TG).
• SACS was validated using a separate multicenter database.

Main Results:

• The SACS demonstrated superior performance in predicting high-grade cholecystitis compared to ESS, AAST, and TG (C-statistic 0.76 vs. 0.60, 0.53, and 0.70, respectively).
• In the validation cohort, SACS maintained strong predictive ability (C-statistic 0.74).
• A SACS cutoff of 4 accurately identified a significant proportion of high-grade cases with high specificity.

Conclusions:

• The Severe Acute Cholecystitis Score (SACS) is a validated tool for preoperative prediction of high-grade acute cholecystitis.
• SACS can assist clinicians in patient counseling and surgical decision-making for acute cholecystitis.