Differential Expression of Preoperative Cholestatic Biochemical Profiles, Inflammatory Factors, and Electrolytes: Risk Stratification Based on Complicated GS
Preoperative Biochemical Profiles in Complicated GS
Abstract
Background: Gallstones (GS) are a highly prevalent digestive disorder worldwide and can readily progress to complicated GS. Most previous studies on GS have focused on isolated indicators, while the interplay among multisystem biochemical markers has received far less attention. This gap makes it difficult to fully explain how the disease evolves. The present study was designed to systematically compare preoperative multidimensional biochemical indices between patients with simple GS and those with complicated GS, and to provide laboratory evidence for clarifying the mechanisms underlying disease progression.
Methods: A total of 107 patients with GS confirmed by imaging between January 2024 and December 2025 were included, including 49 patients in the simple GS group and 58 in the complicated GS group. The test panel covered five modules: the core cholestatic biochemical profile (10 items), bile duct–specific injury and metabolic regulatory markers (GST-α, C4, and FGF19), inflammation- and tissue remodeling–related markers (10 items), electrolyte and acid-base homeostasis indices (10 items), and 15 bile acid subspecies.
Results: The core cholestatic indices were significantly elevated in the complicated group, with TBIL and GGT increasing by 1.87-fold and 4.82-fold, respectively (both P<0.05). GST-α, a bile duct–specific injury marker, was markedly upregulated, whereas the bile acid metabolic regulators FGF19 and C4 were both downregulated (both P<0.05). Among the inflammatory markers, CRP, Presepsin, and several related indices were several-fold higher in the complicated group. These patients also showed electrolyte disturbances, including hypokalemia and hyponatremia, together with metabolic acidosis (BE=-3.36±1.81 mmol/L). All 15 bile acid subspecies were significantly increased, and the rise in conjugated bile acids (8- to 10-fold) was far greater than that in unconjugated bile acids (2- to 5-fold) (all P<0.05).
Conclusion: Simple and complicated GS differed significantly across multiple biochemical dimensions. The findings suggest that cholestasis, inflammatory activation, disturbance of internal homeostasis, and abnormal bile acid metabolism act in concert during disease progression.
Copyright (c) 2026 Xuecui Ge, Tingting Zhang, Changzhou Zhang, Dalu Liu, Chun Zhang
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