The role of serum and urine neopterin levels on the determination of acute cholecystitis intensity

Introduction: Acute cholecystitis is one of the most common reasons for hospital admissions with complaints of abdominal pain. Early diagnosis and early treatment in acute cholecystitis have a positive effect on morbidity and mortality. After acute infection, the illness may regress spontaneously within 7-10 days, or complications may occur. Therefore, patients suspected of acute cholecystitis should be treated definitively. Staging the severity of acute cholecystitis is mandatory for the selection of treatment modalities such as early initiation of treatment and planning cholecystectomy in the early period. Tokyo Guideline 18 is one of the globally accepted guidelines for the staging of acute cholecystitis violence. Neopterin is a pteridine derivative produced by activated monocytes, macrophages, dendritic cells and endothelial cells from guanosine triphosphate via the enzyme guanosine triphosphate cyclohydrolase 1. Changes in serum and urine neopterin levels in some infectious and inflammatory diseases, chronic diseases such as diabetes mellitus, and malignancies have been previously shown. It was aimed to find out whether there is a correlation between neopterin levels and the clinical stages of acute cholecystitis specified in TG18. In this way, it is predicted that neopterin levels can facilitate the staging of acute cholecystitits and shorten the time to initiate treatment. Materials and Methods: In this study; 63 patients who were diagnosed with acute cholecystitis in 2020 by the same team in the Department of General Surgery of Gazi University Faculty of Medicine Hospital and who were treated in an outpatient or inpatient manner were included. In addition to the demographic characteristics of the patients such as age and gender, the infective parameters and imaging methods used in the diagnosis of acute cholecystitis were examined and samples were taken to determine the blood and urine neopterin levels during the diagnosis. Results: The average age of the patients with acute cholecystitis included in our study (n = 63) was 52.93 (± 14.31), 39.6% (n = 25) were female and 60.4% (n = 38) were male. According to Tokyo Guidelines 18; of the cases diagnosed with acute cholecystitis, 58.7% (n = 37) were Stage 1, 28.6% (n = 18) Stage 2, 12.7% (n = 8) Stage 3. A significant difference was found between the stages of acute cholecystitis in terms of serum neopterin values (p <0.01). It was observed that as the severity of the disease increased between the stages of acute cholecystitis, the mean urinary neopterin value increased, but there was no significant difference in urinary neopterin between stages (p = 0.289). Conclusion: In acute cholecystitis patients, White blood cells, C-reaktive protein, Procalcitonin values used in Tokyo Guidelines 18 increase. These values are used to determine the stage of the disease. As the severity of the disease increased, a correlated increase was observed in these infective parameters. In patients with acute cholecystitis; serum neopterin and urınary neopterin levels can be used in addition to existing biomarkers to diagnose and determine clinical staging. Key Words: Cholecystitis, Neopterin, Tokyo Guidelines 2018