RED CELL DISTRIBUTION WIDTH TO DIFFERENTIATE ACUTE CHOLECYSTITIS FROM CHRONIC CHOLECYSTITIS

Background: Morbidity and mortality related to cholecystitis and in particular, the acute forms are not negligible. The role of red cell distribution width (RCDW) in the diagnosis of inflammatory disease was shown by many authors, but studies about its predictive value to diagnose acute cholecystitis and differentiate it from the chronic cholecystitis are scarce. Objective: The aim of this study was to determine the diagnostic accuracy of RCDW as promising diagnostic test to differentiate between acute cholecystitis and chronic cholecystitis. Methods: A retrospective cohort study was performed at King Fahd Hospital, Al-Medina, Saudi Arabia by reviewing the medical case records of the patients. The study included patients from different age groups who underwent laparoscopic cholecystectomy from January 2016 to December 2017. Various preoperative, operative and post-operative data were recorded in a predesigned proforma. Values of RCDW and WBC counts were recorded and compared between acute and chronic cholecystitis patients. Results: A total of 294 cholecystitis patients were included in this study; 56 (19.0%) had acute cholecystitis and 238 (81.0%) had chronic cholecystitis. There was no statistically significant difference between acute and chronic cholecystitis patients in terms of age, gender, BMI and lymphocyte count. The average level of RCDW was significantly different between acute cholecystitis group and chronic cholecystitis group. Receiver operating characteristic curve of RCDW value in diagnosing acute cholecystitis had an area under the curve of 0.706 (p <.001), and the best cut off was 14.15% with a sensitivity of 76.8% and specificity of 51.3%. For WBC count, AUC of the ROC curve was 0.870 with a sensitivity of 91.1% and specificity of 72.7% for a cutoff of 10.93 x 103/µL. Conclusions: RCDW had a satisfactory discriminative value in distinguishing acute cholecystitis from the chronic form. Nevertheless, it would preferable to associate it with WBC count to support the diagnostic approach. Keywords: Acute cholecystitis, Chronic cholecystitis, Red cell distribution width