Diagnostic criteria for oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis

Aim: To identify clinically significant diagnostic criteria for oligosymptomatic choledocholithiasis and determine their diagnostic value in patients with acute calculous cholecystitis (ACC) based on instrumental and laboratory examination data.

Materials and Methods: The study included 129 patients divided into two groups: the study group (I) and the comparison group (II). The study group included patients with ACC and oligosymptomatic choledocholithiasis (n=83), while the comparison group included patients with ACC without OCL (n=46).

Results: A univariate analysis using logistic regression identified nine factors with prognostic value for determining the presence of OCL. A high quality of OCL prediction was observed (AUC=0.99). The optimal decision threshold for diagnosing OCL was 0.5. Sensitivity at the established threshold was 100%, specificity was 88.90%, and accuracy was 96.88% (p <0.001). a multivariate regression model based on six factors was developed to enhance the clinical applicability of OCL prediction in ACC. This model also demonstrated a high predictive quality (AUC=0.98) compared to the nine-factor model. The decision threshold for the presence or absence of OCL was 0.6. The sensitivity of this model was 95.65%, specificity was 88.90%, and accuracy was 93.75%.

Conclusions: The diameter of the common bile duct, the activity of ALT, AST, alkaline phosphatase, total bilirubin levels, as well as the expression levels of miR-122 and miR-21 in serum and bile, serve as reliable diagnostic criteria associated with the presence of oligosymptomatic choledocholithiasis.