https://doi.org/10.4081/ecj.2026.14648
The prognostic role of procalcitonin in predicting mortality after early cholecystectomy in patients with acute calculous cholecystitis
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Published: 1 April 2026
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.
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1. Pisano M, Allievi N, Gurusamy K, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg 2020;15:61.
2. Shaffer EA. Epidemiology and risk factors for gallstone disease: Has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005;7:132-40.
3. Miura F, Takada T, Kawarada Y, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007;14:27-34.
4. Yokoe M, Takada T, Strasberg SM, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2013;20:35-46.
5. Yokoe M, Hata J, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:41-54.
6. Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 2018;25:31-40.
7. Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:73-86.
8. Okamoto K, Suzuki K, Takada T, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2018;25:55-72.
9. Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016;11:25.
10. Escartin A, Gonzalez M, Cuello E, et al. Acute cholecystitis in very elderly patients: disease management, outcomes, and risk factors for complications. Surg Res Pract 2019;2019:9014569.
11. Sato M, Endo K, Harada A, Shijo M. Risk factors of postoperative complications in laparoscopic cholecystectomy for acute cholecystitis. JSLS 2020;24:e2020.00046.
12. Ausania F, Guzman Suarez S, Alvarez Garcia H, Senra del Rio P, et al. Gallbladder perforation: morbidity, mortality and preoperative risk prediction. Surg Endosc 2015;29:955-60.
13. Romano L, Giuliani A, Pessia B, Mattei A, et al. The early prediction of mortality in acute cholecystitis: Temperature, Neutrophils and Multiple organ failure (TNM) score. Eur Rev Med Pharmacol Sci 2021;25:6339-48.
14. Teoh AYB, Kitano M, Itoi T, et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020;69:1085-91.
15. Fugazzola P, Di Martino M, Tomasoni M, et al. Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study. World J Emerg Surg 2023;18:20.
16. Yaow CYL, Chong RIH, Chan KS, Chia CTW, et al. Should procalcitonin be included in acute cholecystitis guidelines? A systematic review. Medicina (Kaunas) 2023;59:732.
17. Sartelli M, Abu-Zidan FM, Catena F, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World J Emerg Surg 2015;10:51.
18. Schuetz P, Beishuizen A, Broyles M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clin Chem Lab Med 2019;57:1308-18.
19. Byrne JJ, Berger RL. The pathogenesis of acute cholecystitis. Arch Surg 1960;81:812-6.
20. Wu T, Luo M, Guo Y, et al. Role of procalcitonin as a predictor in difficult laparoscopic cholecystectomy for acute cholecystitis case: a retrospective study based on the TG18 criteria. Sci Rep 2019;9:13998.
21. Sakalar S, Ozakın E, Cevik AA, et al. Plasma procalcitonin is useful for predicting the severity of acute cholecystitis. Emerg Med Int 2020;2020:8899945.
22. Fransvea P, Covino M, Rosa F, et al. Role of serum procalcitonin in predicting the surgical outcomes of acute calculous cholecystitis. Langenbecks Arch Surg 2021;406:2375-82.
23. Yuzbasioglu Y, Duymaz H, Tanrikulu CS, et al. Role of procalcitonin in evaluation of the severity of acute cholecystitis. Eurasian J Med 2016;48:162-6.
CRediT authorship contribution
Luca Ansaloni, Paola Fugazzola: study conception; Paola Fugazzola, Luca Ansaloni, Andrea Dagnoni, Lorenzo Cobianchi, Francesca Dal Mas, Fikri M Abu-Zidan, Catherine Klersy: manuscript conception and draft and contribute to important scientific knowledge; Catherine Klersy, Fikri M Abu-Zidan statistical analysis of the data. Paola Fugazzola, Andrea Dagnoni, Lorenzo Cobianchi, Francesca Dal Mas, Carlo Bianchi, Fikri M Abu-Zidan, Matteo Tomasoni, Fausto Catena, Catherine Klersy, Ahmed Ghaly, Enrico Cicuttin, Simone Frassini, Valeria Musella, Jacopo Viganò, Fausto Catena, Luca Ansaloni gave substantial contributions to the interpretation of data for the work and critically revised the manuscript; Paola Fugazzola, Andrea Dagnoni, Valeria Musella, Walter Biffi, Massimo Sartelli and S.P.Ri.M.A.C.C. Collaborative Group: substantial contributions to the acquisition of data and draft critically revised. All authors gave the final approval and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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