Association of Serum CX3CL1 and TSLP Expression with Postoperative Pain Severity in Patients Undergoing Laparoscopic...

To investigate the association between preoperative serum CX3CL1 and TSLP levels and postoperative pain severity in patients with acute calculous cholecystitis undergoing laparoscopic cholecystectomy (LC).

We prospectively enrolled 379 patients with acute calculous cholecystitis undergoing LC. According to the 24-hour postoperative visual analog scale (VAS) score, patients were classified into mild pain (MP, n=261) and moderate-to-severe pain (MSP, n=118) groups. Preoperative serum CX3CL1 and TSLP were measured by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curves were constructed to evaluate their predictive value, alone and in combination. Multivariable logistic regression identified independent risk factors. A nomogram was developed and internally validated using a 7:3 split.

Preoperative serum CX3CL1 and TSLP levels were significantly higher in the MSP group (both P<0.001). Both showed moderate positive correlations with C-reactive protein (CRP) and postoperative VAS scores (r=0.410-0.456). The combined biomarker model (CX3CL1 + TSLP) achieved an area under the curve (AUC) of 0.860 (95% confidence interval [CI], 0.819-0.900). Multivariable logistic regression identified gallbladder wall thickness, onset-to-surgery time, intraoperative drainage tube placement, Tokyo Guidelines 2018 (TG18) grade, Generalized Anxiety Disorder-7 (GAD-7) score, Patient Health Questionnaire-9 (PHQ-9) score, Athens Insomnia Scale (AIS) score, CRP, CX3CL1, and TSLP as independent risk factors. The nomogram demonstrated AUCs of 0.859 and 0.892 in the training and validation sets, with good calibration and clinical net benefit.

Elevated preoperative serum CX3CL1 and TSLP levels are independently associated with moderate-to-severe pain following LC, and their combined detection may help identify high-risk patients. The nomogram integrating these biomarkers with clinical risk factors shows favorable predictive performance; however, external multicenter validation is required before clinical application.