Factors influencing the cure of pseudolithiasis: a retrospective study of 264 patients.

Abstract

Objective: To identify independent predictors of complete resolution in patients with pseudobiliary calculi and evaluate the effectiveness of different therapeutic strategies.

Methods: Clinical data were retrospectively analyzed from 264 patients with pseudobiliary calculi admitted to The First Hospital of Lanzhou University between January 2018 and December 2019. Patients were categorized into complete resolution group (n = 43) and persistent group (n = 221) based on discharge CT findings. Univariate and multivariate logistic regression analyses were performed to assess the impact of demographic characteristics, laboratory parameters, comorbidities, and therapeutic interventions on prognosis.

Results: Among 264 enrolled patients, 43 (16.29%) achieved complete resolution while 221 (83.71%) showed persistent calculi. Univariate analysis revealed significant differences between groups in gender (χ² = 4.738, P = 0.030), concurrent cholecystitis (χ² = 24.424, P < 0.001), cholangitis (P = 0.001), viral hepatitis (χ² = 3.957, P = 0.047), decompensated cirrhosis (χ² = 6.827, P = 0.009), Age Groups (t=-2.232, P = 0.030), AST/ALT ratio (t = 6.340, P < 0.001), and white blood cell count (t=-3.103, P = 0.002). Therapeutic interventions, including ceftazidime (χ² = 11.21, P = 0.001), mezlocillin (P = 0.014), ornidazole (χ² = 6.317, P = 0.012), and iodinated contrast media (χ² = 5.271, P = 0.022), showed statistically significant differences between groups. Multivariable logistic regression analysis shows that acute cholecystitis [OR = 0.237, 95% CI (0.106-0.529), P < 0.001], cholangitis [OR = 0.258, 95% CI (0.075-0.889), P = 0.032], and elevated white blood cell count [OR = 0.876, 95% CI (0.806-0.953), P = 0.002] are negatively associated with the resolution of pseudolithiasis. In contrast, the increase in the AST/ALT ratio [OR = 5.132, 95% CI(2.063-12.766), P < 0.001] and the use of iodinated contrast agents [OR = 3.944, 95% CI(1.262-12.33), P = 0.018] are continuously positively correlated with pseudolithiasis.In addition, the use of ceftazidime [OR = 0.291, 95% CI (0.121-0.701), P = 0.006] and mezlocillin [OR = 0.045, 95% CI (0.004-0.531), P = 0.014] has a significant promoting effect on the resolution of pseudolithiasis. These findings provide a systematic analysis of potential predictive factors associated with the complete resolution of pseudobiliary stones, offering preliminary evidence for further optimization of personalized treatment strategies.

Conclusion: Our research indicates that, unlike chronic cholelithiasis, pseudolithiasis exhibits uniqueness and temporality. The underlying inflammatory gallbladder diseases and their treatments may facilitate the rapid resolution of pseudolithiasis, while factors such as viral hepatitis and decompensated cirrhosis may affect liver function and bile composition but do not appear to directly contribute to the occurrence of pseudolithiasis. Furthermore, differences in sex hormone levels may result in a higher rate of short-term resolution of pseudolithiasis in male patients compared to females. These findings provide preliminary evidence for the prevention and management strategies of pseudolithiasis.