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Association of Serum Ferritin and Cytokine Profile With Severity of Acute Cholecystitis in Patients Undergoing Laparoscopic Cholecystectomy.
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Noor Shafqat, Ahmed Rafique, Sumreen, Aslam Tahir, Azhar Sarah, Mehwish Alina
Аннотация
BACKGROUND: Acute cholecystitis is a common surgical emergency. Early assessment of disease severity is important for safe laparoscopic cholecystectomy in routine hospital practice in Pakistan. Serum ferritin and inflammatory cytokines may reflect the intensity of systemic inflammation. This study assessed their association with acute cholecystitis severity.
METHODS: This observational study was conducted at Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Pakistan, over six months, starting in March 2025. Ninety-four adults with acute cholecystitis undergoing laparoscopic cholecystectomy were included by consecutive sampling. Patients were classified into Grade I, II, and III according to the Tokyo Guidelines 2018. Serum ferritin, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and IL-10 were measured before surgery. Complete blood count, C-reactive protein (CRP), bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were also recorded. Correlation and multivariable regression analyses were performed.
RESULTS: Of 94 patients, 38 (40.4%) had Grade I, 39 (41.5%) Grade II, and 17 (18.1%) Grade III disease. Median ferritin increased from 146 ng/mL in Grade I to 428 ng/mL in Grade III (p<0.001). IL-6 increased from 13.2 to 56.8 pg/mL, while TNF-α increased from 10.8 to 39.5 pg/mL (both p<0.001). IL-10 increased from 6.4 to 14.2 pg/mL (p=0.002). Ferritin correlated with disease grade (r=0.64, p<0.001), while IL-6 showed the strongest correlation (r=0.72, p<0.001). After adjustment, ferritin, IL-6, and TNF-α remained independently associated with severe disease.
CONCLUSION: Serum ferritin and inflammatory cytokines, particularly IL-6 and TNF-α, were associated with increasing acute cholecystitis severity. Their use alongside routine inflammatory markers may help identify high-risk patients and support closer monitoring and better surgical planning before early laparoscopic cholecystectomy in routine hospital practice in Pakistan.
METHODS: This observational study was conducted at Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Pakistan, over six months, starting in March 2025. Ninety-four adults with acute cholecystitis undergoing laparoscopic cholecystectomy were included by consecutive sampling. Patients were classified into Grade I, II, and III according to the Tokyo Guidelines 2018. Serum ferritin, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and IL-10 were measured before surgery. Complete blood count, C-reactive protein (CRP), bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were also recorded. Correlation and multivariable regression analyses were performed.
RESULTS: Of 94 patients, 38 (40.4%) had Grade I, 39 (41.5%) Grade II, and 17 (18.1%) Grade III disease. Median ferritin increased from 146 ng/mL in Grade I to 428 ng/mL in Grade III (p<0.001). IL-6 increased from 13.2 to 56.8 pg/mL, while TNF-α increased from 10.8 to 39.5 pg/mL (both p<0.001). IL-10 increased from 6.4 to 14.2 pg/mL (p=0.002). Ferritin correlated with disease grade (r=0.64, p<0.001), while IL-6 showed the strongest correlation (r=0.72, p<0.001). After adjustment, ferritin, IL-6, and TNF-α remained independently associated with severe disease.
CONCLUSION: Serum ferritin and inflammatory cytokines, particularly IL-6 and TNF-α, were associated with increasing acute cholecystitis severity. Their use alongside routine inflammatory markers may help identify high-risk patients and support closer monitoring and better surgical planning before early laparoscopic cholecystectomy in routine hospital practice in Pakistan.