Incidence of acute cholecystitis underwent cholecystectomy in incident dialysis patients: a nationwide population-based cohort study in Korea

Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease

INTRODUCTION

The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities.

METHODS

A total of 270 patients (90 with chronic kidney disease stages III-V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups.

FINDINGS

Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006).

DISCUSSION

Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.

Medical management or surgery for acute cholecystitis: Enhancing treatment selection with decision trees

BACKGROUND

This study aimed to create an algorithm using the decision tree method to classify patients with suspected acute cholecystitis into those who may improve with medical treatment, those who should undergo surgery for acute cholecystitis, and those with complicated cholecystitis, using laboratory parameters alone.

METHODS

A total of 1,352 patients treated for acute cholecystitis at our hospital over four years were retrospectively analyzed. Patients were divided into groups based on whether they received medical treatment or surgery. Various demographic and laboratory parameters were recorded. A decision tree algorithm was used to classify patients based on these parameters. Statistical analyses were performed using SPSS, and the decision tree's performance was evaluated with 10-fold cross-validation. An additional decision tree was created for gangrenous cholecystitis using the same methods.

RESULTS

The decision tree identified the platelet-to-lymphocyte ratio (PLR) as the most critical parameter for distinguishing between patients requiring surgery and those suitable for conservative treatment. The algorithm demonstrated an 82.17% diagnostic accuracy for predicting operative need and a 73.86% accuracy for identifying gangrenous cholecystitis. C-reactive protein (CRP) levels, platelet (PLT) values, white blood cell (WBC) counts, and patient age were also significant factors in the decision-making process. The neutrophil-to-lymphocyte ratio (NLR) was the most useful for diagnosing necrosis.

CONCLUSION

The decision tree algorithm effectively differentiates between uncomplicated and complicated cholecystitis using easily obtainable laboratory parameters. This method offers a cost-effective, rapid alternative to imaging studies, facilitating timely and appropriate treatment decisions, ultimately improving patient outcomes and reducing healthcare costs.