Hypoglycemia is a strong independent predictor of mortality in acute calculous cholecystitis.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42296768.
- Also identified by DOI 10.1016/j.surg.2026.110325.
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Abstract
Acute calculous cholecystitis is a frequent reason for surgical admissions. Most patients improve, but 0.6%-6.0% succumb to their disease. The Tokyo classification helps predict outcomes, but only in Tokyo 3, which represents a small portion of patients admitted and who will experience mortality. We lack accurate predictive tools in lower Tokyo scores. Hypoglycemia has been demonstrated as a prognostic marker of poor outcomes in other settings. Single-center retrospective cohort study of acute calculous cholecystitis between January 2015 and December 2018. Demographic, clinical, and laboratory data were collected, including treatments, intensive care unit admission, Tokyo score, American Society of Anesthesiology score, and mortality. Hypoglycemia was defined as any documented serum glucose ≤70 mg/dL (3.89 mmol/L), regardless of symptoms. Cox regression was performed to ascertain parameters independently associated with mortality. Included 1,447 patients with acute calculous cholecystitis. The incidence of hypoglycemia was 15% and occurred on a median hospital day 2. Mortality occurred in 6.8% of the entire cohort, and specifically, in 2.5%, 7.9%, and 24.5% in Tokyo 1, 2, and 3, respectively. Cox regression showed age (hazard ratio, 1.071; P < .001), intensive care unit admission (hazard ratio, 15.8; P < .001), Tokyo score (hazard ratio, 1.792; P = .001), and hypoglycemia (hazard ratio, 2.006; P = .001) independently associated with mortality. Regression models for each Tokyo score demonstrated that hypoglycemia was associated with mortality in Tokyo 1 with a hazard ratio of 3.258 (P = .041) and in Tokyo 2 with a hazard ratio of 1.841 (P = .049). Hypoglycemia occurs frequently in acute calculous cholecystitis and is a significant prognosticator of mortality, independent of Tokyo and American Society of Anesthesiology guidelines. This is specifically powerful and useful in lower Tokyo classifications that lack accurate predictive tools.