The efficiency of serum sodium level in predicting the percutaneous cholecystostomy requirement in Grade 2 acute cholecystitis patients.

BACKGROUND

Acute cholecystitis is a common and benign gallbladder disease frequently encountered in surgical practice. Diagnosis and treatment are managed in 3 groups following the updated 2018 Tokyo Guideline. Percutaneous cholecystostomy is recommended as an adjunct to conservative treatment for patients at grades 2 and 3. We aimed to evaluate hyponatremia's role in predicting percutaneous cholecystostomy and identify a cutoff value.

MATERIALS AND

METHODS

The patients admitted to the hospital diagnosed with acute cholecystitis between January 2020 and December 2024 were investigated. One hundred seven patients were included in the study who were evaluated as grade 2 based on the Tokyo Guideline. The patients were divided into 2 groups: with percutaneous cholecystostomy and without percutaneous cholecystostomy. The groups were compared based on descriptive characteristics, physical examinations and imaging findings, blood parameters, and duration of hospitalization. The efficacy of sodium levels in predicting the necessity for percutaneous cholecystostomy and the severity of the disease was investigated.

RESULTS

Twenty-three (21.5%) and 84 (78.5%) patients were treated with conventional and percutaneous cholecystostomy, respectively. No statistically significant difference was observed between the groups with and without percutaneous cholecystostomy for age, gender, gallbladder wall thickness, and presence of gallbladder hydrops (P = .555, P =.499, P =.635, and P = .773). Blood parameters such as white blood cell (P = .496), C-reactive protein (P = .937), alanine aminotransferase (P = .180), gamma-glutamyl transferase (P =.056), and alkaline phosphatase (P = .079) were not statistically significantly different between the groups. A statistically significant difference was observed in aspartate aminotransferase between the groups (P = .021). A statistically significant difference was observed between the distributions of mean hospitalization sodium and median sodium levels on the day of percutaneous cholecystostomy in the 2 groups (P = .002 and P < .001). The cutoff value of serum sodium for percutaneous cholecystostomy insertion was 133.5 mEq/L in the receiver operating characteristic curve analysis.

CONCLUSION

Individualization of the management of grade 2 patients and determination of objective values are critical to ensuring that each patient receives the correct treatment. Our study is the first in its field, highlighting the critical role of hyponatremia in necessitating percutaneous cholecystostomy. It also establishes a cutoff number, underscoring its importance for the literature.