Abstract: Objective The aim of this study was to investigate serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein (CRP), direct bilirubin (DBIL) and albumin (ALB) levels in diagnosing acute severe cholangitis (ASC) in patients with common bile duct stones. Methods 201 patients with common bile duct stones were encountered in our hospital between January 2019 and December 2023, and ASC was diagnosed based on Charcot's triad, clinical tests and imaging manifestation. Serum sTREM-1 level was detected by flow fluorescence luminescence. Multivariate binary Logistic regression analysis was applied to analyze the factors impacting the occurrence of ASC. Receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate diagnostic efficacy. Results Of the 201 patients with common bile duct stones in our series, ASC was found in 28 cases (13.9%); incidences of impacted stone, gallbladder stones and Charcot's triad in ASC group were much higher than in patients without ASC (P<0.05); serum sTREM-1, CRP and DBIL levels were (313.7±53.6)pg/mL, (88.5±16.8)mg/L and (44.9±6.5)μmol/L, all significantly higher than [(178.9±29.5)pg/mL, (22.0±12.7)mg/L and (34.2±5.4)μmol/L, respectively, P<0.05], while serum albumin level was(32.9±4.9)g/L, significantly lower than [(39.1±5.6)g/L,P<0.05] in those without ASC; multivariate Logistic regression analysis showed that serum sTREM-1(OR=1.740,95%CI:1.267-2.391),CRP(OR=1.675,95%CI:1.157-2.426)and DBIL(OR=1.590,95%CI:1.197-2.113) were all the independent risk factors for occurrence of ASC (P<0.05), while serum ALB(OR=0.768,95%CI:0.629-0.938) was the protective one (P<0.05);ROC analysis demonstrated that the AUC was 0.903(95% CI:0.854-0.940), with a good diagnostic performance, when serum sTREM-1 was combined with CRP, DBIL and/or ALB levels. Conclusion Serum sTREM-1, CRP and DBIL levels elevate, and/or serum ALB level decrease in patients with common bile duct stones, which might help diagnose ASC when Charcot's triad appears.

Key words: Common bile duct stones, Acute severe cholangitis, Soluble triggering receptor expressed on myeloid cells-1, C-reactive protein, Direct bilirubin, Albumin, Diagnosis