Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study.
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Velamazán Raúl, López-Guillén Pablo, Martínez-Domínguez Samuel J, Abad Baroja Daniel, Oyón Daniel, Arnau Anna, Ruiz-Belmonte Lara M, Tejedor-Tejada Javier, Zapater Raul, Martín-Vicente Noelia, Fernández-Esparcia Pedro José, Julián Gomara Ana Belén, Sastre Lozano Violeta, Manzanares García Juan José, Chivato Martín-Falquina Irene, Andrés Pascual Laura, Torres Monclus Nuria, Zaragoza Velasco Natividad, Rojo Eukene, Lapeña-Muñoz Berta, Flores Virginia, Díaz Gómez Arantxa, Cañamares-Orbís Pablo, Vinzo Abizanda Isabel, Marcos Carrasco Natalia, Pardo Grau Laura, García-Rayado Guillermo, Millastre Bocos Judith, Garcia Garcia de Paredes Ana, Vaamonde Lorenzo María, Izagirre Arostegi Arantzazu, Lozada-Hernández Edgard Efrén, Velarde-Ruiz Velasco José Antonio, de-Madaria Enrique
Аннотация
OBJECTIVE: We aimed to determine the pattern of relapse in each symptomatic gallstone disease (acute pancreatitis, cholecystitis, cholangitis, symptomatic choledocholithiasis, and biliary colic) and determine the associated factors.
METHODS: RELAPSTONE was an international multicenter retrospective cohort study. Patients (n = 3016) from 18 tertiary centers who suffered a first episode of symptomatic gallstone disease from 2018 to 2020 and had not undergone cholecystectomy during admission were included. The main outcome was relapse-free survival. Kaplan-Meier curves were used in the bivariate analysis. Multivariable Cox regression models were used to identify prognostic factors associated with relapses.
RESULTS: Mean age was 76.6 [IQR: 59.7-84.1], and 51% were male. The median follow-up was 5.3 months [IQR 2.1-12.4]. Relapse-free survival was 0.79 (95% CI: 0.77-0.80) at 3 months, 0.71 (95% CI: 0.69-0.73) at 6 months, and 0.63 (95% CI: 0.61-0.65) at 12 months. In multivariable analysis, older age (HR = 0.57; 95% CI: 0.49-0.66), sphincterotomy (HR = 0.58, 95% CI: 0.49-0.68) and higher leukocyte count (HR = 0.79; 95% CI: 0.70-0.90) were independently associated with lower risk of relapse, whereas higher levels of alanine aminotransferase (HR = 1.22; 95% CI: 1.02-1.46) and multiple cholelithiasis (HR = 1.19, 95% CI: 1.05-1.34) were associated with higher relapse rates.
CONCLUSION: The relapse rate is high and different in each symptomatic gallstone disease. Our independent predictors could be useful for prioritizing patients on the waiting list for cholecystectomies.