Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2018; 6(11): 441-446
Published online Oct 6, 2018. doi: 10.12998/wjcc.v6.i11.441
Diagnostic value of elevated serum carbohydrate antigen 199 level in acute cholangitis secondary to choledocholithiasis
Yong Mei, Li Chen, Ci-Jun Peng, Jun Wang, Peng-Fei Zeng, Guo-Xing Wang, Wen-Ping Li, Yan-Qing Luo, Chao Du, Kai Liu, Kun Xiong, Kai Leng, Chun-Lin Feng, Ji-Hu Jia
Yong Mei, Jun Wang, Peng-Fei Zeng, Guo-Xing Wang, Wen-Ping Li, Yan-Qing Luo, Chao Du, Kai Liu, Kun Xiong, Kai Leng, Chun-Lin Feng, Ji-Hu Jia, Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Li Chen, Diagnostics Laboratory, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Ci-Jun Peng, Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Mei Y and Chen L contributed equally to this work; Mei Y, Chen L, Peng CJ and Leng K participated in study design, and drafted the manuscript; Wang J, Zeng PF, Wang GX, Li WP, Luo YQ, Du C, Liu K, Xiong K, Leng K and Feng CL participated in data collection and performed the statistical analysis; all authors have read and approved the final manuscript.
Supported by the Fund from the Guizhou Provincial Department of Health Science and Technology, No. GZWJKJ2014-2-151; the Science and Technology Fund of Guizhou Province, No. QKH LH [2016] 7421; and Zunyi Science and Technology Research and Development Fund, No. ZSKHS [2016] 06.
Institutional review board statement: The study was approved by the Ethics Committee of the Third Affiliated Hospital of Zunyi Medical University, No. ZSYYLL116.
Informed consent statement: All clinical data were collected with informed consent obtained from study participants.
Conflict-of-interest statement: All authors declare that they have no any conflicts of interest related to this study.
STROBE statement: This report is presented as suggested by the STROBE statement, i.e., according to the guidelines for reporting observational studies.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kai Leng, PhD, Chief Doctor, Professor, Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital of Zunyi Medical University, 98 Fenghuang Load, Zunyi 563000, Guizhou Province, China. lengkai4757zsyy@163.com
Telephone: +86-8512-8923927 Fax: +86-8512-8923927
Received: May 27, 2018
Peer-review started: May 27, 2018
First decision: July 3, 2018
Revised: July 23, 2018
Accepted: August 19, 2018
Article in press: August 20, 2018
Published online: October 6, 2018
Processing time: 125 Days and 3.3 Hours
Abstract
AIM

To investigate the diagnostic value of abnormal serum carbohydrate antigen 199 (CA199) level in acute cholangitis secondary to choledocholithiasis.

METHODS

In this retrospective cohort study, the clinical data of 727 patients with choledocholithiasis admitted to the Third Affiliated Hospital of Zunyi Medical College from June 2011 to June 2017 were collected. Among these patients, 258 patients had secondary acute cholangitis and served as observation group, and the remaining 569 choledocholithiasis patients served as the control group. Serum liver function indexes and tumor markers were detected in both groups, and the receiver operating characteristic (ROC) curves were constructed for markers showing statistical significances. The cutoff value, sensitivity, and specificity of each marker were calculated according to the ROC curves.

RESULTS

The results of liver function tests showed no significant differences between the two groups (P > 0.05). Tumor markers including serum CA125, CA153, carcinoembryonic antigen, and alpha fetoprotein levels were also not significantly different (P > 0.05); however, the serum CA199 level was significantly higher in the observation group than in the control group (P < 0.05). The ROC curve analysis showed that the area under the curve was 0.885 (95%CI: 0.841-0.929) for CA199, and the cutoff value of 52.5 kU/L had the highest diagnostic accuracy, with a sensitivity of 86.8% and a specificity of 81.6%.

CONCLUSION

Abnormally elevated serum CA199 level has an important value in the diagnosis of acute cholangitis secondary to choledocholithiasis. It may be a specific inflammatory marker for acute cholangitis.

Keywords: Carbohydrate antigen 199; Tumor marker; Choledocholithiasis; Inflammatory marker; Diagnosis; Acute cholangitis

Core tip: Acute cholangitis is an acute inflammatory response to increased bile duct pressure and bacterial infection following biliary obstruction, whereas biliary obstruction is mostly caused by choledocholithiasis. Failure of timely predicting the onset of acute cholangitis may lose the chance for a minimally invasive surgery and result in a high mortality of the patients. In this study, a total of 727 choledocholithiasis patients were included, and the results suggest that abnormally elevated serum carbohydrate antigen 199 level has an important value in the diagnosis of acute cholangitis secondary to choledocholithiasis. It may be a specific inflammatory marker for acute cholangitis. As a convenient and rapid test, it is worthy to be applied in clinical settings.