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Published on: June 11, 2012

Hypoglycemia is a strong independent predictor of mortality in acute calculous cholecystitis

Shachar Laks1, Eyal Leibovitz2, Chaled Alnakib1

  • 1Department of Surgery "A", Edith Wolfson Medical Center, Holon, Israel; Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.

Surgery
|June 15, 2026
PubMed

Insights

Hypoglycemia in acute calculous cholecystitis predicts mortality, especially in lower Tokyo classifications. This finding offers a new prognostic tool for patient outcomes.

Area of Science:

  • Gastroenterology
  • Surgical Outcomes
  • Critical Care Medicine

Background:

  • Acute calculous cholecystitis is a common cause of surgical admission with significant mortality.
  • The Tokyo classification aids outcome prediction but is limited in lower severity scores.
  • Hypoglycemia is a known marker for adverse outcomes in various medical conditions.

Purpose of the Study:

  • To investigate hypoglycemia as a prognostic marker for mortality in acute calculous cholecystitis.
  • To assess the independent association of hypoglycemia with mortality across different Tokyo classification scores.

Main Methods:

  • Retrospective cohort study of 1,447 patients with acute calculous cholecystitis (January 2015-December 2018).
  • Data collected included demographics, clinical factors, laboratory results, Tokyo score, ASA score, and mortality.
  • Hypoglycemia defined as serum glucose ≤70 mg/dL; Cox regression analyzed mortality predictors.

Main Results:

  • 15% of patients experienced hypoglycemia, with a median hospital day of 2.
  • Overall mortality was 6.8%; mortality rates varied by Tokyo score (2.5% for Tokyo 1, 7.9% for Tokyo 2, 24.5% for Tokyo 3).
  • Hypoglycemia independently predicted mortality (HR 2.006, P=.001), particularly in Tokyo 1 (HR 3.258, P=.041) and Tokyo 2 (HR 1.841, P=.049) classifications.

Conclusions:

  • Hypoglycemia is a frequent and significant predictor of mortality in acute calculous cholecystitis.
  • This association is independent of established scoring systems like Tokyo and ASA.
  • Hypoglycemia serves as a valuable prognostic tool, especially for patients with lower Tokyo scores lacking precise predictive capabilities.
Abstract

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