Total bilirubin trend as a predictor of common bile duct stones in acute cholecystitis and symptomatic cholelithiasis


      • Patients with acute cholecystitis or biliary colic often have elevated bilirubin.
      • Trending elevated bilirubin does not help predict common bile duct stones (CBDS).
      • Patients with elevated bilirubin should undergo immediate imaging or surgery.
      • White blood cell count trending opposite bilirubin may be predict CBDS.



      We hypothesized that trends in total bilirubin in the context of cholecystitis and symptomatic cholelithiasis could be used to guide testing for the presence of common bile duct stones (CBDS).


      A review of adult patients with acute cholecystitis or biliary colic with elevated total bilirubin and at least two levels drawn prior to procedural intervention was performed. Trends of total bilirubin and other serum makers were examined to predict the presence of CBDS.


      The total bilirubin level at presentation, average over 24 h and average over 48 h (3.74 mg/dl vs. 2.29 mg/dl, p = 0.005; 3.72 mg/dl vs. 2.40 mg/dl, p = 0.009; 2.41 mg/dl vs. 1.47 mg/dl, p < 0.001) respectively, were all higher in those with CBDS. However, prediction was not improved by following levels over time.


      Patients presenting with elevated serum bilirubin, should undergo immediate imaging or procedural intervention rather than obtaining follow-up bilirubin levels.


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