FACTORS PREDICTIVE OF BILE-DUCT STONES IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS

The objective of the study was to investigate the accuracy of using pr eoperative data for the prediction of bile duct calculi in patients op erated on for acute cholecystitis. 279 consecutive patients underwent cholecystectomy with peroperative cholangiography for acute calculous cholecystitis in the Department of Surgery, Lund University Hospital, between 1985 and 1991. The correlation between 13 preoperative clinica l and laboratory variables, and the incidence of bile duct calculi was studied. Among the 13 variables tested, serum bilirubin concentration and serum gamma-glutamyltransferase activity were independent factors of predictive significance. These two factors were used for construct ing an additive prognostic index for the presence of bile duct stones. Thus, three groups of patients could be identified having a 3, 7-9 or 59% risk of harboring bile duct stones, corresponding to a sensitivit y of 61% and a specificity of 93% in predicting the presence of bile d uct stones in the 'high-risk' group. Logistic regression analysis perm its accurate preoperative identification of bile duct stones in patien ts with acute calculous cholecystitis.