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Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis
  1. Liqaa Raffee1,
  2. Samer Kuleib1,2,
  3. Alaa Oteir3,4,
  4. Tariq Kewan5,
  5. Khaled Alawneh6,
  6. Bronwyn Beovich4,
  7. Brett Williams4
  1. 1Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
  2. 2Accident and Emergency, King Abdullah University Hospital, Irbid, Jordan
  3. 3Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
  4. 4Community Emergency Health and Paramedic Practice, Monash University, Peninsula Campus, Frankston, Victoria, Australia
  5. 5Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
  6. 6Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
  1. Correspondence to Dr Liqaa Raffee, Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology Faculty of Medicine, Irbid 22110, Jordan; laraffee5{at}


Background Acute cholecystitis is an emergency condition. If not promptly diagnosed and properly managed, the complication of gangrenous cholecystitis may develop, which may be a life-threatening complication.

Objectives The study aims to examine various characteristics and physiological parameters in patients diagnosed with acute cholecystitis to evaluate if significant predictive factors exist for the differential diagnosis of gangrenous cholecystitis.

Materials and methods This was a retrospective study included patients with acute cholecystitis diagnosis, who presented to ‘blinded for peer review’ from 1 January 2010 to 1 January 2017. Parameters evaluated included liver function tests, complete cell count, C reactive protein, erythrocyte sedimentation rate (ESR), amylase and lipase levels, as well as medical history, and presenting clinical signs. Cases were divided according to whether or not there was a histopathological diagnosis of gangrenous cholecystitis.

Results A total of 186 (54.5%) female and 155 (45.5%) male cases were examined. Patients with gangrenous cholecystitis tended to be male, showed a significantly higher white cell count, higher neutrophil percentage, lower lymphocyte percentage and higher ESR compared with patients without gangrenous cholecystitis. However, serum amylase and lipase demonstrated no differential diagnostic utility

Conclusion Male patients with a high ESR level, high total leucocyte count with a relative high proportion of neutrophils and a low proportion of lymphocytes were found to be at increased risk of the presence of gangrenous cholecystitis.

  • gangrenous
  • cholecystitis
  • parameters
  • leucocytes
  • enzymes
  • emergency department
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  • Contributors LR and SK conceived the study. LR, SK, KA and TK collected the data. AO, BW and BB conducted the data analysis. BB, BW, AO and LR wrote the manuscript. All coauthors critically reviewed and approved the final draft of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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