ASSOCIATION OF LABORATORY MARKERS WITH THE DURATION OF JAUNDICE IN COMPLICATED CHOLEDOCHOLITHIASIS

Abstract

Introduction. Choledocholithiasis is a common complication of gallstone disease, with a frequency ranging from 8 to 16 %. Untreated choledocholithiasis can be a common cause of repeated hospital visits and progress to life-threatening complications, including acute cholangitis or biliary pancreatitis. Scientific data show that the presence of jaundice is one of the significant clinical predictors of gallstone disease. Prolonged mechanical jaundice significantly increases the risk of hepatic-renal failure, biliary sepsis, and acute cholangitis, which directly correlates with high postoperative morbidity and mortality. The Aim of the Study – to establish the relationship between the duration of jaundice and laboratory markers in patients with choledocholithiasis complicated by cholangitis and biliary pancreatitis. Research Methods. The study included a clinical examination and analysis of laboratory data from 122 inpatients with choledocholithiasis (ChL), complicated either by cholangitis (n = 59) or biliary pancreatitis (n = 63) upon admission. Results and Discussion. Comparative analysis of laboratory parameters in patients with complicated choledocholithiasis demonstrated significant differences between the observation groups. Analysis of associations between the duration of jaundice and laboratory markers showed no correlation between the level of gammaglutamyl transpeptidase (GGT) and the duration of jaundice in the cholangitis group. In contrast, complications involving biliary pancreatitis were accompanied by a weak positive correlation between the investigated parameters. A significant positive correlation was established between the level of L-FABP, ALT and total bilirubin with the duration of jaundice in ChL patients complicated by both cholangitis and biliary pancreatitis. Conclusions. Patients with choledocholithiasis complicated by cholangitis exhibit a significantly more pronounced cytolytic syndrome and hepatocyte damage compared to those with biliary pancreatitis. This is confirmed by reliably higher levels of L-FABP (by 1,35 times), ALT (by 1,51 times), and AST (by 1,55 times) (p < 0,05). The greatest prognostic significance regarding the duration of jaundice in biliary pancreatitis belongs to total bilirubin (r = 0,50), indicating a direct dependence of bilirubin accumulation on the time of persistent obstruction, whereas GGT was found to be uninformative for predicting the duration of obstruction in cholangitis.