The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?
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De Simone Belinda, Abu-Zidan Fikri M, Chouillard Elie, Di Saverio Salomone, Sartelli Massimo, Podda Mauro, Gomes Carlos Augusto, Moore Ernest E, Moug Susan J, Ansaloni Luca, Kluger Yoram, Coccolini Federico, Landaluce-Olavarria Aitor, Estraviz-Mateos Begoña, Uriguen-Etxeberria Ana, Giordano Alessio, Luna Alfonso Palmieri, Amín Luz Adriana Hernández, Hernández Adriana María Palmieri, Shabana Amanda, Dzulkarnaen Zakaria Andee, Othman Muhammad Asyraf, Sani Mohamad Ikhwan, Balla Andrea, Scaramuzzo Rosa, Lepiane Pasquale, Bottari Andrea, Staderini Fabio, Cianchi Fabio, Cavallaro Andrea, Zanghì Antonio, Cappellani Alessandro, Campagnacci Roberto, Maurizi Angela, Martinotti Mario, Ruggieri Annamaria, Jusoh Asri Che, Rahman Karim Abdul, Zulkifli Anis Suraya M, Petronio Barbara, Matías-García Belén, Quiroga-Valcárcel Ana, Mendoza-Moreno Fernando, Atanasov Boyko, Campanile Fabio Cesare, Vecchioni Ilaria, Cardinali Luca, Travaglini Grazia, Sebastiani Elisa, Chooklin Serge, Chuklin Serhii, Cianci Pasquale, Restini Enrico, Capuzzolo Sabino, Currò Giuseppe, Filippo Rosalinda, Rispoli Michele, Aparicio-Sánchez Daniel, Muñóz-Cruzado Virginia Durán, Barbeito Sandra Dios, Delibegovic Samir, Kesetovic Amar, Sasia Diego, Borghi Felice, Giraudo Giorgio, Visconti Diego, Doria Emanuele, Santarelli Mauro, Luppi Davide, Bonilauri Stefano, Grossi Ugo, Zanus Giacomo, Sartori Alberto, Piatto Giacomo, De Luca Maurizio, Vita Domenico, Conti Luigi, Capelli Patrizio, Cattaneo Gaetano Maria, Marinis Athanasios, Vederaki Styliani-Aikaterini, Bayrak Mehmet, Altıntas Yasemin, Uzunoglu Mustafa Yener, Demirbas Iskender Eren, Altinel Yuksel, Meric Serhat, Aktimur Yunus Emre, Uymaz Derya Salim, Omarov Nail, Azamat Ibrahim, Lostoridis Eftychios, Nagorni Eleni-Aikaterini, Pujante Antonio, Anania Gabriele, Bombardini Cristina, Bagolini Francesco, Gonullu Emre, Mantoglu Baris, Capoglu Recayi, Cappato Stefano, Muzio Elena, Colak Elif, Polat Suleyman, Koylu Zehra Alan, Altintoprak Fatih, Bayhan Zülfü, Akin Emrah, Andolfi Enrico, Rezart Sulce, Kim Jae Il, Jung Sung Won, Shin Yong Chan, Enciu Octavian, Toma Elena Adelina, Medas Fabio, Canu Gian Luigi, Cappellacci Federico, D'Acapito Fabrizio, Ercolani Giorgio, Solaini Leonardo, Roscio Francesco, Clerici Federico, Gelmini Roberta, Serra Francesco, Rossi Elena Giulia, Fleres Francesco, Clarizia Guglielmo, Spolini Alessandro, Ferrara Francesco, Nita Gabriela, Sarnari Jlenia, Gachabayov Mahir, Abdullaev Abakar, Poillucci Gaetano, Palini Gian Marco, Veneroni Simone, Garulli Gianluca, Piccoli Micaela, Pattacini Gianmaria Casoni, Pecchini Francesca, Argenio Giulio, Armellino Mariano Fortunato, Brisinda Giuseppe, Tedesco Silvia, Fransvea Pietro, Ietto Giuseppe, Franchi Caterina, Carcano Giulio, Martines Gennaro, Trigiante Giuseppe, Negro Giulia, Vega Gustavo Machain, González Agustín Rodríguez, Ojeda Leonardo, Piccolo Gaetano, Bondurri Andrea, Maffioli Anna, Guerci Claudio, Sin Boo Han, Zuhdi Zamri, Azman Azlanudin, Mousa Hussam, Al Bahri Shadi, Augustin Goran, Romic Ivan, Moric Trpimir, Nikolopoulos Ioannis, Andreuccetti Jacopo, Pignata Giusto, D'Alessio Rossella, Kenig Jakub, Skorus Urszula, Fraga Gustavo Pereira, Hirano Elcio Shiyoiti, de Lima Bertuol Jackson Vinícius, Isik Arda, Kurnaz Eray, Asghar Mohammad Sohail, Afzal Ameer, Akbar Ali, Nikolouzakis Taxiarchis Konstantinos, Lasithiotakis Konstantinos, Chrysos Emmanuel, Das Koray, Özer Nazmi, Seker Ahmet, Ibrahim Mohamed, Hamid Hytham K S, Babiker Ahmed, Bouliaris Konstantinos, Koukoulis George, Kolla Chrysoula-Christina, Lucchi Andrea, Agostinelli Laura, Taddei Antonio, Fortuna Laura, Agostini Carlotta, Licari Leo, Viola Simona, Callari Cosimo, Laface Letizia, Abate Emmanuele, Casati Massimiliano, Anastasi Alessandro, Canonico Giuseppe, Gabellini Linda, Tosi Lorenzo, Guariniello Anna, Zanzi Federico, Bains Lovenish, Sydorchuk Larysa, Iftoda Oksana, Sydorchuk Andrii, Malerba Michele, Costanzo Federico, Galleano Raffaele, Monteleone Michela, Costanzi Andrea, Riva Carlo, Walędziak Maciej, Kwiatkowski Andrzej, Czyżykowski Łukasz, Major Piotr, Strzałka Marcin, Matyja Maciej, Natkaniec Michal, Valenti Maria Rosaria, Di Vita Maria Domenica Pia, Sotiropoulou Maria, Kapiris Stylianos, Massalou Damien, Veroux Massimiliano, Volpicelli Alessio, Gioco Rossella, Uccelli Matteo, Bonaldi Marta, Olmi Stefano, Nardi Matteo, Livadoti Giada, Mesina Cristian, Dumitrescu Theodor Viorel, Ciorbagiu Mihai Calin, Ammendola Michele, Ammerata Giorgio, Romano Roberto, Slavchev Mihail, Misiakos Evangelos P, Pikoulis Emmanouil, Papaconstantinou Dimitrios, Elbahnasawy Mohamed, Abdel-Elsalam Sherief, Felsenreich Daniel M, Jedamzik Julia, Michalopoulos Nikolaos V, Sidiropoulos Theodoros A, Papadoliopoulou Maria, Cillara Nicola, Deserra Antonello, Cannavera Alessandro, Negoi Ionuţ, Schizas Dimitrios, Syllaios Athanasios, Vagios Ilias, Gourgiotis Stavros, Dai Nick, Gurung Rekha, Norrey Marcus, Pesce Antonio, Feo Carlo Vittorio, Fabbri Nicolo', Machairas Nikolaos, Dorovinis Panagiotis, Keramida Myrto D, Mulita Francesk, Verras Georgios Ioannis, Vailas Michail, Yalkin Omer, Iflazoglu Nidal, Yigit Direnc, Baraket Oussama, Ayed Karim, Ghalloussi Mohamed Hedi, Patias Parmenion, Ntokos Georgios, Rahim Razrim, Bala Miklosh, Kedar Asaf, Sawyer Robert G, Trinh Anna, Miller Kelsey, Sydorchuk Ruslan, Knut Ruslan, Plehutsa Oleksandr, Liman Rumeysa Kevser, Ozkan Zeynep, Kader Saleh Abdel, Gupta Sanjay, Gureh Monika, Saeidi Sara, Aliakbarian Mohsen, Dalili Amin, Shoko Tomohisa, Kojima Mitsuaki, Nakamoto Raira, Atici Semra Demirli, Tuncer Gizem Kilinc, Kaya Tayfun, Delis Spiros G, Rossi Stefano, Picardi Biagio, Del Monte Simone Rossi, Triantafyllou Tania, Theodorou Dimitrios, Pintar Tadeja, Salobir Jure, Manatakis Dimitrios K, Tasis Nikolaos, Acheimastos Vasileios, Ioannidis Orestis, Loutzidou Lydia, Symeonidis Savvas, de Sá Tiago Correia, Rocha Mónica, Guagni Tommaso, Pantalone Desiré, Maltinti Gherardo, Khokha Vladimir, Abdel-Elsalam Wafaa, Ghoneim Basma, López-Ruiz José Antonio, Kara Yasin, Zainudin Syaza, Hayati Firdaus, Azizan Nornazirah, Khei Victoria Tan Phooi, Yi Rebecca Choy Xin, Sellappan Harivinthan, Demetrashvili Zaza, Lekiashvili Nika, Tvaladze Ana, Froiio Caterina, Bernardi Daniele, Bonavina Luigi, Gil-Olarte Angeles, Grassia Sebastiano, Romero-Vargas Estela, Bianco Francesco, Gumbs Andrew A, Dogjani Agron, Agresta Ferdinando, Litvin Andrey, Balogh Zsolt J, Gendrikson George, Martino Costanza, Damaskos Dimitrios, Pararas Nikolaos, Kirkpatrick Andrew, Kurtenkov Mikhail, Gomes Felipe Couto, Pisanu Adolfo, Nardello Oreste, Gambarini Fabrizio, Aref Hager, Angelis Nicola De', Agnoletti Vanni, Biondi Antonio, Vacante Marco, Griggio Giulia, Tutino Roberta, Massani Marco, Bisetto Giovanni, Occhionorelli Savino, Andreotti Dario, Lacavalla Domenico, Biffl Walter L, Catena Fausto
Аннотация
METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.
RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001].
CONCLUSIONS: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.