The prognostic role of procalcitonin in predicting mortality after early cholecystectomy in patients with acute calculous cholecystitis

Recent studies have shown that Procalcitonin (PCT) can predict severity, difficult laparoscopic cholecystectomy, open conversion, and post-operative morbidity after Early Cholecystectomy (EC) in patients with Acute Calculous Cholecystitis (ACC). However, these studies are limited by their small sample sizes and lack of statistical power. The present study is a post-hoc analysis of a large prospective study (the S.P.Ri.M.A.C.C. study) to evaluate the value of PCT, as a predictor for mortality after EC. The S.P.Ri.M.A.C.C. study is an observational multicentre prospective study endorsed by the World Society of Emergency Surgery (WSES). 1253 patients from 79 locations in 19 countries were enrolled between September 1, 2021, and September 1, 2022. In this post-hoc analyses, patients with incomplete information regarding PCT value were excluded. The Receiving Operating Characteristic (ROC) curve and Area Under the Curve (AUC) were used to study the diagnostic ability of PCT. Exact logistic regression model was used to define the Odds Ratio (OR). 612 patients were included in this post-hoc analysis. The AUC of the PCT value as a continuous variable in predicting 30-day mortality was 0.926 (95% CI 0.874-0.978). The best cut-off in predicting 30-day mortality was 4 ng/mL with a sensitivity of 90.9% (95% CI 58.7%-99.8%) and a specificity of 88% (95% CI 85.1%-90.5%). The negative predicting value for mortality was 99.8% (95%CI 98.9%-100%), while the positive predicting value was 12.2% (95%CI 6.01%-21.3%). Patients with a PCT³4 ng/mL had 72.19 (95%CI 10.01-3175.90) times higher odds to die after EC than patients with a PCT<4 ng/ml. The present study demonstrated the prognostic value of pre-operative PCT in predicting 30-day mortality after EC in patients with ACC.