BACKGROUND: Gangrenous cholecystitis (GC) is considered a more severe form of acute cholecystitis. The risk factors associated with this condition and its impact on morbidity and mortality compared with those of non-gangrenous acute cholecystitis (NGAC) are poorly defined and based largely on findings from older studies. METHODS: Patients with histologically confirmed acute cholecystitis treated in specialized units in a tertiary hospital between 2005 and 2010 were identified from a prospectively maintained database. Data were reviewed retrospectively and patients with GC were compared with those with NGAC. RESULTS: A total of 184 patients with NGAC and 106 with GC were identified. The risk factors associated with GC included older age (69 years vs. 57 years; P= 0.001), diabetes (19% vs. 10%; P= 0.049), temperature of >38 degrees C (36% vs. 16%; P < 0.001), tachycardia (31% vs. 15%; P= 0.002), detection of muscle rigidity on examination (27% vs. 12%; P= 0.01) and greater elevations in white cell count (WCC) (13.4 x 10/l vs. 10.7 x 10/l; P < 0.001), C-reactive protein (CRP) (94 mg/l vs. 17 mg/l; P= 0.001), bilirubin (19 micromol/l vs. 17 micromol/l; P= 0.029), urea (5.3 mmol/l vs. 4.7 mmol/l; P= 0.016) and creatinine (82 micromol/l vs. 74 micromol/l; P= 0.001). The time from admission to operation in days was greater in the GC group (median = 1 day, range: 0-14 days vs. median = 1 day, range: 0-10 days; P= 0.029). There was no overall difference in complication rates between the GC and NGAC groups (22% vs. 14%; P= 0.102). There was a lower incidence of common bile duct stones in the GC group (5% vs. 13%; P= 0.017). Gangrenous cholecystitis was associated with increased mortality (4% vs. 0%; P= 0.017), but this was not an independent risk factor on multivariate analysis. CONCLUSIONS: Gangrenous cholecystitis has certain clinical features and associated laboratory findings that may help to differentiate it from NGAC. It is not associated with an overall increase in complications when treated in a specialized unit.
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机译：背景：坏疽性胆囊炎（GC）被认为是急性胆囊炎的一种更严重的形式。与非坏疽性急性胆囊炎（NGAC）相比，与这种疾病相关的风险因素及其对发病率和死亡率的影响定义不明确，并且主要基于较早的研究结果。方法：从前瞻性维护的数据库中识别出2005年至2010年间在三级医院的专门科中经组织学确认的急性胆囊炎的患者。回顾性分析数据，将GC患者与NGAC患者进行比较。结果：总共鉴定出184例NGAC患者和106例GC患者。与GC相关的危险因素包括年龄较大（69岁vs. 57岁; P = 0.001），糖尿病（19％vs. 10％; P = 0.049），体温> 38摄氏度（36％vs. 16％; 38％）。 P <0.001），心动过速（31％比15％; P = 0.002），检查时检测到的肌肉僵硬（27％比12％; P = 0.01）以及白细胞计数（WCC）更高的升高（13.4 x 10 / l对10.7 x 10 / l; P <0.001），C反应蛋白（CRP）（94 mg / l对17 mg / l; P = 0.001），胆红素（19 micromol / l对17 micromol / l; P = 0.029），尿素（5.3 mmol / l vs. 4.7 mmol / l; P = 0.016）和肌酐（82 micromol / l vs. 74 micromol / l; P = 0.001）。 GC组从入院到手术的时间以天为单位更长（中位数= 1天，范围：0-14天，中位数= 1天，范围：0-10天; P = 0.029）。 GC组和NGAC组之间的并发症发生率没有总体差异（22％vs. 14％; P = 0.102）。 GC组胆总管结石的发生率较低（5％比13％; P = 0.017）。坏疽性胆囊炎与死亡率增加相关（4％vs. 0％; P = 0.017），但这并不是多因素分析的独立危险因素。结论：坏疽性胆囊炎具有某些临床特征和相关的实验室检查结果，可能有助于将其与NGAC区别开来。在专科病房中治疗时，它与并发症的总体增加无关。
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