Tissue Cytokines Reveal Gender Difference in Acute Cholecystitis
Lauren Buck*2, Jill C. Fehrenbacher3, Kenneth Hargreaves3, Wayne H. Schwesinger2, Kent Van Sickle2, Juliane Bingener1
1Division of General Surgery, Mayo Clinic - Rochester, Rochester, MN; 2Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX; 3Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX
Background: Male sex is a predictor for poor outcomes in patients with cholecystitis. Socioeconomic factors or gender-dependent inflammatory modulation may contribute to negative clinical outcomes.Patients and Methods: Patients presenting with acute or chronic cholecystitis for laparoscopic cholecystectomy were prospectively enrolled in the study. Acute cholecystitis was defined as a patient with unrelenting right upper quadrant pain, tenderness, and/or elevated WBC count, temperature, or ultrasonographic signs of acute cholecystitis. Demographic and socioeconomic data were obtained with a detailed survey. Interstitial fluid from gallbladder fundus and infundibulum biopsies were analyzed for inflammatory cytokines and estradiol using a multiplex cytometric bead assay and estradiol enzyme immunoassay. ANOVA and logistic regression was used for statistical analysis. The study was IRB approved.Results: Clinical data for 89 patients (27 men, 62 women; mean age 37 yrs, mean BMI 32) were analyzed; tissue cytokine results were available for 64 patients. A WBC > 11,000 (OR 2.7, CI 1,02-7.2, p=0.045) and a temperature >100○ F correlated with acute cholecystitis. No difference in WBC count, temperature, BMI, insurance status, or level of education was encountered between genders. Patients with acute cholecystitis had higher interleukin and lower tissue estradiol levels than patients with chronic cholecystitis. Men with acute cholecystitis had significantly higher tissue levels of IL-1b, IL-8, and IL-10 but not IL-6 or Estradiol than women (table). Conclusion: Significant differences in tissue level cytokines by disease state and sex were encountered although clinical presentation and socioeconomic status for men or women was not significantly different.
Tissue cytokine levels by disease state and gender
| Cytokine | Acuten=30 | Chronicn=34 | P value | Acute malen=12 | Acute femalen=18 | P value |
| Estradiol(ng/mL) | 7.9 ± 2.6 | 17.5 ± 3.3 | 0.01 | 5.2 ± 2.1 | 9.7 ± 4.1 | n.s. |
| IL-6(ng/mL) | 10.8 ± 2.0 | 3.5 ± 0.1 | 0.0004 | 14.0 ± 3.2 | 8.7 ± 2.4 | n.s. |
| IL-8(ng/mL) | 16.5 ± 2.7 | 4.0 ± 1.0 | 0.0001 | 25.5 ± 4.3 | 10.4 ± 3.0 | 0.002 |
| IL-10(pg/mL) | 24.6 ± 4.0 | 12.2 ± 1.6 | 0.002 | 38.8 ± 8.5 | 15.2 ± 2.5 | 0.002 |
| IL-1β(pg/mL) | 1145 ± 291 | 452 ± 116 | 0.01 | 1971 ± 605 | 595 ± 236 | 0.01 |
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