C-REACTIVE PROTEIN, AN ACUTE PHASE REACTANT PROTEIN, AS A PREDICTOR FOR COMPLICATED LAPAROSCOPIC CHOLECYSTECTOMY

Resumen

Background: Laparoscopic cholecystectomy (LC) is the best treatment of symptomatic cholelithiasis. Nevertheless, some of the patients go through challenging operations, raising the chances of having complications like bile duct damage, extreme operation duration, and open surgery. Difficult LC is hard to predict at an early stage. C-reactive protein (CRP), an inflammatory protein that is associated with acute phases, has also become a possible predictor of the difficulty of surgical operations. Objective: The aim of the study is to establish the diagnostic value of preoperative CRP levels in the prediction of complicated laparoscopic cholecystectomy with the help of per-operative findings as the gold standard. Methodology: The study was a cross-sectional validation study done at the Department of Surgery, Fauji foundation Hospital, Rawalpindi from October 2025 to February 2026. Non-probability consecutive sampling was used to select 297 patients at the age of 12 to 70 years with ultrasound confirmed cholelithiasis. A 95% level of confidence, 14.5% prevalence of complicated laparoscopic surgery, 10% level of error, 87% sensitivity and 97% specificity were used to calculate the sample size. Patients who have ASA 3 or more, BMI over 35, deranged liver function tests, obstructive jaundice, choledocholithiasis, previous abdominal surgery or immunocompromised condition were excluded. Measurement of preoperative CRP was done with the cut off level of 11mg/dl. The Nassar classification (Grade III/IV or conversion to open surgery) was used to measure surgical difficulty. Sensitivity, specificity, PPV, NPV and ROC curve analysis were used to assess diagnostic accuracy. Results: The high specificity of CRP levels in preoperative period and high diagnostic accuracy of the tests indicated that complicate LC were predicted and results agreed with other studies that indicated high diagnostic accuracy up to 95.5. Conclusion Preoperative CRP was a low-cost, easy to use biomarker which helped surgeons predict challenging laparoscopic cholecystectomy, optimize surgical planning and decrease perioperative morbidity.