{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:04:45Z","timestamp":1761919485594},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2011,11,1]],"date-time":"2011-11-01T00:00:00Z","timestamp":1320105600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2011,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives:<\/jats:title><jats:p>The aim of the study was to investigate the etiology, clinical presentation, and risk factors for poor prognosis of acute acalculous cholecystitis (AAC) in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods:<\/jats:title><jats:p>Children younger than 18 years diagnosed as having AAC were analyzed retrospectively from 2000 to 2009. The demographic and clinical characteristics, etiology, and outcomes were recorded. AAC was defined as a gallbladder wall thickness of &gt;3.5 mm in sonogram with a duration of symptoms &lt;1 month. The severity of sonographic findings was scored, with 1 point each given for wall thickness &gt;3.5 mm, gallbladder distention, sludge, and pericholecystic fluid.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>A total of 109 children (boys:girls 1:2, median age 4.9 years) were diagnosed. The most common clinical presentation was fever (88%), followed by hepatomegaly (72%). The rates of elevated alanine aminotransferase and thrombocytopenia were 72% and 65%, respectively. The most common causative etiology was infectious diseases (74%). All of the patients were treated nonoperatively. Sixteen (15%) patients died. Children with mortality had a significantly higher rate of septic shock (<jats:italic>P<\/jats:italic> &lt; 0.001), anemia (<jats:italic>P<\/jats:italic> = 0.01), thrombocytopenia (<jats:italic>P<\/jats:italic> = 0.04), hypofibrinogenemia (<jats:italic>P<\/jats:italic> = 0.002), the presence of pericholecystic fluid (<jats:italic>P<\/jats:italic> = 0.04), and higher sonographic scores (<jats:italic>P<\/jats:italic> = 0.04) than those with survival. Multiple logistic regression analysis confirmed that the presence of septic shock (<jats:italic>P<\/jats:italic> = 0.004) and hypofibrinogenemia (<jats:italic>P<\/jats:italic> = 0.014) were independent risk factors that predict mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>Childhood AAC is usually secondary to a variety of etiologies, especially during the course of infectious diseases. The presence of septic shock and a low value of fibrinogen determine a fatal outcome in childhood AAC.<\/jats:p><\/jats:sec>","DOI":"10.1097\/mpg.0b013e318230c380","type":"journal-article","created":{"date-parts":[[2011,10,4]],"date-time":"2011-10-04T20:58:48Z","timestamp":1317761928000},"page":"548-552","source":"Crossref","is-referenced-by-count":7,"title":["Septic Shock and Hypofibrinogenemia Predict a Fatal Outcome in Childhood Acute Acalculous Cholecystitis"],"prefix":"10.1002","volume":"53","author":[{"given":"Shu\u2010Ching","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Pediatrics Kuo General Hospital Tainan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao\u2010Jong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics National Cheng Kung University and Hospital Tainan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2011,11]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"690","article-title":"Gall bladder disease in infants and children","volume":"63","author":"Graivier L","year":"1968","journal-title":"Surgery"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8553(21)00361-7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197904000-00013"},{"key":"e_1_2_8_5_1","first-page":"33","article-title":"Acalculous cholecystitis","volume":"159","author":"Lee AW","year":"1984","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1975.01360110089016"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(96)90334-6"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(83)90042-9"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-007-6115-y"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)90259-3"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.147.6.1171"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02067089"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01893137"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2002.29423"},{"key":"e_1_2_8_15_1","first-page":"773","article-title":"Gastrointestinal complications after cardiac surgery","volume":"104","author":"Krasna MJ","year":"1988","journal-title":"Surgery"},{"key":"e_1_2_8_16_1","first-page":"1431","article-title":"Acute acalculous cholecystitis in typhoid fever","volume":"29","author":"Subba Rao SD","year":"1992","journal-title":"Indian Pediatr"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199004000-00009"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-002-0826-z"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(97)70238-5"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203308098587"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1536-4801.2000.tb07122.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.05.1712"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.213.3.r99dc17831"}],"container-title":["Journal of Pediatric Gastroenterology and Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/MPG.0b013e318230c380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T12:32:28Z","timestamp":1705581148000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1097\/MPG.0b013e318230c380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,11]]},"references-count":22,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2011,11]]}},"alternative-id":["10.1097\/MPG.0b013e318230c380"],"URL":"https:\/\/doi.org\/10.1097\/mpg.0b013e318230c380","archive":["Portico"],"relation":{},"ISSN":["0277-2116","1536-4801"],"issn-type":[{"value":"0277-2116","type":"print"},{"value":"1536-4801","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,11]]}}}