Laboratory Elevations in Gallstone Disease

Bilirubin Elevation in Gallstone Disease

15-50% of patients with acute calculous cholecystitis (ACC) show elevated bilirubin without any common bile duct stones (CBDS) due to acute inflammatory processes, according to the World Society of Emergency Surgery 1, 2
The World Society of Emergency Surgery strongly recommends against using elevated bilirubin as the only method to identify common bile duct stones, as elevated bilirubin alone has only a 15% positive predictive value for CBDS 1, 2, 3

Alkaline phosphatase (ALP) is elevated in 77% of patients with CBDS, with sensitivity of 92% at cut-off >125 IU/L, as reported by Praxis Medical Insights 3
ALT is elevated in approximately 90% of patients with choledocholithiasis, and 50% of ACC patients without CBDS show elevated ALT, according to the World Journal of Emergency Surgery and Praxis Medical Insights 2, 3
AST elevation occurs in 41-51% of ACC patients without CBDS, as found by the World Journal of Emergency Surgery 2
Gamma-glutamyl transpeptidase (GGT) shows 80.6% sensitivity and 75.3% specificity for CBDS at cut-off of 224 IU/L, according to the World Journal of Emergency Surgery 2