Risk Factors Associated With Gangrenous Cholecystitis: A Cohort Study From Eastern India

Treating gangrenous cholecystitis (GC) can be a challenge. It necessitates urgent intervention due to its elevated mortality risk. Prompt identification of risk factors and intervention are essential for halting inflammatory cascade and preventing further complications. This study aimed to evaluate the factors for early prediction of gangrenous changes in patients with acute cholecystitis.

A prospective study was carried out among 340 diagnosed adult acute cholecystitis patients, admitted under the Department of General Surgery of a tertiary medical college between May 2022 and April 2024. Data were compiled into Excel and analyzed using the SPSS (Statistical Product and Service Solutions) software (IBM SPSS Statistics for Windows, Version 21.0. IBM Corp., Armonk, NY). Data were analyzed using descriptive statics, chi-square test, and unpaired t-test. A p-value less than 0.05 was considered statistically significant.

Out of 340 acute cholecystitis patients, 27 (7.9%) progressed to GC. It was more prevalent among males (22/27, 81.5%), among patients in the 51-70 years age group (15/27, 55.5%), and among patients with comorbidities (diabetes mellitus and coronary artery disease) (23/27, 85.2%) with a significant association (p < 0.001, p = 0.010, and p < 0.001, respectively). The presence of fever (p = 0.002) and vomiting (p = 0.040) was significantly associated with gangrenous outcomes in the patients. The mean values of lab parameters like White Blood Cells (WBCs), serum bilirubin (SBIL), serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and alkaline phosphatase (ALP) were significantly higher among patients with GC. Ultrasound imaging parameters showed a significantly higher asymmetrical gallbladder (GB) wall (27, 100%), intraluminal membrane (23/27, 85.2%), pericholecystic collection (23/27, 85.2%), and acalculous GB (9/27, 33.3%) among GC patients. In the case of Contrast-Enhanced Computed Tomography (CECT) for GC, the test demonstrated relatively high sensitivity (74.1%) and specificity (85.6%). All patients with GC underwent emergency cholecystectomy.

The study highlighted various demographic, clinical, and imaging factors linked to a high risk of developing GC, including older age, male gender, elevated laboratory markers (such as WBC count, SBIL, SGOT, SGPT, and ALP), and imaging features like GB calculi, increased GB wall thickness, wall symmetry, intraluminal membrane, and pericholecystic collection. Employing a comprehensive approach that incorporates demographic, clinical, and imaging data is essential for predicting and guiding treatment decisions effectively.