Abstract
Background
Existing guidelines for predicting common bile duct stones (CBDS) are not specific for acute calculous cholecystitis (ACC). This paper is a posthoc analysis of the S.P.Ri.M.A.C.C study aiming to prospectively validate on a large independent cohort of patients the Israeli Score (IS) in predicting CBDS in patients with ACC.
Methods
The S.P.Ri.M.A.C.C. study is an observational multicenter prospective study endorsed by the World Society of Emergency Surgery (WSES). Between September 1st, 2021, and September 1st, 2022, 1201 participants were included. The Chi-Square test was used to compare categorical data. A Cochran-Armitage test was run to determine whether a linear trend existed between the IS and the presence of CBDS. To assess the accuracy of the prediction model, the receiver operating characteristic (ROC) curve was generated, and the area under the ROC curve (AUC) was calculated. Logistic regression was run to obtain Odds Ratio (OR). A two-tailed p < 0.05 was considered statistically significant.
Results
The rate of CBDS was 1.8% in patients with an IS of 0, 4.2% in patients with an IS of 1, 24.5% in patients with 2 and 56.3% in patients with 3 (p < 0.001). The Cochran-Armitage test of trend showed a statistically significant linear trend, p < 0.001. Patients with an IS of 3 had 64.4 times (95% CI 24.8–166.9) higher odds of having associated CBDS than patients with an IS of 0. The AUC of the ROC curve of IS for the prediction of CBDS was 0.809 (95% CI 0.752–0.865, p < 0.001). By applying the highest cut-off point (3), the specificity reached 99%, while using the lowest cut-off value (0), the sensitivity reached 100%.
Conclusion
The IS is a reliable tool to predict CBDS associated with ACC. The algorithm derived from the IS could optimize the management of patients with ACC.
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Data availability
The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author at reasonable request.
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Acknowledgements
S.P.Ri.M.A.C.C. Collaborative Group: Goran Augustin (1), Trpimir Morić (1), Selmy Awad (2), Azzah M Alzahrani (2), Mohamed Elbahnasawy (3), Damien Massalou (4), Belinda De Simone (5), Zaza Demetrashvili (6), Athina-Despoina Kimpizi (7), Dimitrios Schizas (8), Dimitrios Balalis (9), Nikolaos Tasis (10), Maria Papadoliopoulou (11), Petrakis Georgios (12), Konstantinos Lasithiotakis (13), Orestis Ioannidis (14), Lovenish Bains (15), Matteo Magnoli (16), Pasquale Cianci (17), Nunzia Ivana Conversano (17), Alessandro Pasculli (18), Jacopo Andreuccetti (19), Elisa Arici (19), Giusto Pignata (19), Guido A.M. Tiberio (20), Mauro Podda (21), Cristina Murru (22), Massimiliano Veroux (23),Costanza Distefano (23), Danilo Centonze (23), Francesco Favi (24), Raffaele Bova (24), Girolamo Convertini (24), Vanni Agnoletti (24), Andrea Balla (25), Diego Sasia (26), Giorgio Giraudo (26), Anania Gabriele (27), Nicola Tartaglia (28), Giovanna Pavone (28), Fabrizio D'Acapito (29), Nicolò Fabbri (30), Francesco Ferrara (31), Stefania Cimbanassi (32), Luca Ferrario (32), Stefano Cioffi (32), Marco Ceresoli (33), Chiara Fumagalli (33), Luca Degrate (33), Maurizio Degiuli (34), Silvia Sofia (34), Leo Licari (35), Andrea Anderloni (36), Tommaso Dominioni (36), Marcello Maestri (36), Camilla Nikita Farè (36), Benedetta Sargenti (36), Mario Improta (36), Valeria Musella (36), Giulia Gambini (36), Alberto Patriti (37),Diego Coletta (37), Luigi Conti (38), Michele Malerba (39), Muratore Andrea (40), Marcello Calabrò (40), Beatrice De Zolt (40), Gabriele Bellio (41), Alessio Giordano (42), Davide Luppi (43), Carlo Corbellini (44),Gianluca Matteo Sampietro (44), Chiara Marafante (45), Stefano Rossi (46), Andrea Mingoli (47), Pierfrancesco Lapolla (47), Pierfranco M Cicerchia (47), Leandro Siragusa (48), Michele Grande (48), Claudio Arcudi (49), Amedeo Antonelli (49), Danilo Vinci (49), Ciro De Martino (50), Mariano Fortunato Armellino (50), Enrica Bisogno (50), Diego Visconti (51), Mauro Santarelli (51), Elena Montanari (51), Alan Biloslavo (52), Paola Germani (52), Claudia Zaghi (53), Naoki Oka (54), Mohd Azem Fathi (55), Daniel Ríos-Cruz (56), Edgard Efren Lozada Hernandez (57), Ibrahim Umar Garzali (58), Liliana Duarte (59), Ionut Negoi (60), Andrey Litvin (61), Sharfuddin Chowdhury (62), Salem M. Alshahrani (62), Silvia Carbonell-Morote (63), Juan J. Rubio-Garcia (63), Claudia Cristina Lopes Moreira (64), Iñigo Augusto Ponce (64), Fernando Mendoza-Moreno (65), Anna Muñoz Campaña (66), Heura Llaquet Bayo (66), Andrea Campos Serra (66), Begoña Estraviz-Mateos (67), Izaskun Markinez-Gordobil (67), Aitor Landaluce-Olavarria (67), Mario Serradilla-Martín (68), Antonio Cano-Paredero (68), Miguel Ángel Dobón-Rascón (68), Hytham Hamid (69), Oussama Baraket (70), Emre Gonullu (71), Sezai Leventoglu (72), Yilmaz Turk (72), Çağrı Büyükkasap (72), Ulaş Aday (73), Yasin Kara (74), Hamit Ahmet Kabuli (75), Semra Demirli Atici (76), Elif Colak (77), Serge Chooklin (78), Serhii Chuklin (78), Elena Martín-Pérez (79), Ángela de la Hoz Rodríguez (79), Marcello Di Martino (80), Salomone Di Saverio (81), Ari Leppäniemi (82), Ernest E. Moore (83), Andrew B. Peitzman (84), Massimo Sartelli (85), Walter Biffl (86). (1) Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia. 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LA, PF: study conception; PF, LA, LC, FDM: manuscript conception and draft and contribute to important scientific knowledge; PF statistical analysis of the data. EC, LC, FDM, SF, TM, JV, MT, FC, LA critically revised the manuscript; PF, MT and S.P.Ri.M.A.C.C. Collaborative Group: data collection and draft critically revised. All authors gave the final approval.
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Paola Fugazzola, Enrico Cicuttin, Lorenzo Cobianchi, Francesca Dal Mas, Tommaso Dominioni, Simone Frassini, Matteo Tomasoni, Jacopo Viganò, Fausto Catena and Luca Ansaloni have no conflicts of interest or financial ties to disclose.
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The study protocol was approved by the medical Ethics Board of the trial coordinating center at the IRCCS San Matteo Hospital, Pavia (Italy). Secondary approvals were obtained from all local ethics committees in the participating centers.
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Fugazzola, P., Cobianchi, L., Dal Mas, F. et al. Prospective validation of the Israeli Score for the prediction of common bile duct stones in patients with acute calculous cholecystitis. Surg Endosc 37, 8562–8569 (2023). https://doi.org/10.1007/s00464-023-10442-x
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DOI: https://doi.org/10.1007/s00464-023-10442-x