Symptomatic uncomplicated gallstone disease is associated with a high short-term risk of gallstone-related complications: a contemporary cohort study

Figures & data

Figure 1. Inclusion of patients.

Figure 2. Cumulative incidence of gallstone complications for individuals diagnosed with symptomatic, uncomplicated gallstone disease on the island of Funen in Denmark in the period 1 January 2020 to 1 July 2023.

Table 1. Characteristics of individuals diagnosed with symptomatic uncomplicated gallstone disease on Funen from 1 January 2020 to 1 July 2023.

Covariate	Patients with symptomatic uncomplicated gallstone disease
Number, total	286
Males, n (%)	85 (29.7)
Age, median (interquartile range)	52 (32-68)
Body mass index, mean (SD)*	31.4 (18.9)
Unknown (%)	70 (24)
Smoking history
Current (%)	53(19)
Former (%)	54 (19)
Never (%)	147 (51)
Unknown (%)	32 (11)
Alcohol consumption:
None (%)	112 (39)
Less than 14/21 units per week (%)	118 (41)
More than 14/21 units per week (%)	26 (9)
Unknown (%)	31 (11)
Cholesterol level:
< 5.0 (%)	110 (38)
5.0–6.4 (%)	49 (17)
6.5–7.9 (%)	11 (4)
> 7.9 (%)	3 (1)
Unknown (%)	113 (40)
Hormone replacement therapy or oral contraceptive (%)	58 (20)
Pregnancies:
Current (%)	12 (4)
Previous (%)	116 (41)
Unknown (%)	41 (14)
Liver disease: (%)	6 (2)
Bowel disease: (%)	3 (1)
Gallstones detected by:
Ultrasound (%)	240 (84)
MRI (%)	9 (3)
CT (%)	35 (12)
Unknown (%)	2 (0.7)
Gallstone characteristics:
Number:
1 (%)	58 (20)
More than 1 (including sludge) (%)	188 (66)
Unknown (%)	40 (14)
Size, largest:
≤10 mm (%)	55 (19)
>10 mm (%)	83 (29)
Unknown (%)	148 (52)
Follow-up in months, median (IQR)	11.8 (3.4–44.5)
First complication:
Cholecystitis (%)	73 (26%)
Pancreatitis (%)	33 (12%)
Cholangitis (%)	7 (2%)
CBD stones or ERCP without pancreatitis or cholangitis (%)	17 (6%)
Unremitting pain necessitating cholecystectomy (%)	46 (16%)
None (%)	110 (38%)
Elective cholecystectomy (%)	85 (30%)
Death (%)	2 (0.7%)

Abbreviations:.

* Mean BMI calculated after multiple imputation.

Table 2. Risk factors associated with any gallstone-related complication for patients with incident symptomatic uncomplicated gallstone disease on funen from 1 January 2020 – 1 July 2023.

Covariate	Crude hazard ratio (95% CI) for any complication	p-value	Adjusted hazard ratio (95% CI) for any complication^¶	p-value
Male gender	0.90 (0.66–1.24)	0.53
Age (10-year increase):	0.93 (0.85–1.01)	0.08	0.99 (0.87–1.13)	0.91
Ethnicity other than Scandinavian	0.92 (0.54–1.56)	0.76
Gallstone characteristics:
Multiple, including sludge	1.50 (1.06–2.12)	0.02	1.24 (0.77–2.02)	0.38
Size (1 mm increase)	0.97 (0.95–1.00)	0.07	0.98 (0.95–1.01)	0.13
Body mass index category increase:	1.08 (0.92–1.27)	0.33
Smoking history:
Current	0.90 (0.61–1.33)	0.61
Former	0.90 (0.60–1.34)	0.59
Alcohol consumption:
Less than 14/21 units per week	0.82 (0.60–1.13)	0.23
More than 14/21 units per week	0.72 (0.41–1.26)	0.25
Hypercholesterolemia:	0.78 (0.50–1.23)	0.29
Hormone therapy:	1.12 (0.70–1.79)	0.63
Previous or current pregnancies:	0.89 (0.57–1.40)	0.62

^¶ For the adjusted analysis, there was only complete data on 138 patients.

Table 3. Risk factors associated with cholecystitis for patients with incident symptomatic uncomplicated gallstone disease on Funen from 1 January 2020 – 1 July 2023.

Covariate	Crude hazard ratio (95% CI) for cholecystitis	p-value	Adjusted hazard ratio (95% CI) for cholecystitis	p-value
Male gender	1.57 (0.98–2.51)	0.06	1.95 (0.98–3.88)	0.06
Age (10-year increase):	1.13 (1.00–1.29)	0.05	1.19 (0.97–1.47)	0.10
Ethnicity other than Scandinavian	0.71 (0.29–1.76)	0.46
Gallstone characteristics:
Multiple, including sludge	1.02 (0.61–1.69)	0.95
Size (1 mm increase)	1.03 (0.99–1.07)	0.10	1.03 (0.99-1.06)	0.15
Body mass index category increase:	0.95 (0.75–1.20)	0.66
Smoking history:
Current	1.13 (0.63–2.01)	0.69
Former	0.92 (0.50–1.70)	0.80
Alcohol consumption:
Less than 14/21 units per week	1.06 (0.65–1.74)	0.81
More than 14/21 units per week	1.23 (0.56–2.68)	0.61
Hypercholesterolemia:	0.94 (0.48–1.84)	0.85
Hormone therapy:	0.69 (0.30–1.59)	0.39
Previous pregnancies:	1.20 (0.61–2.37)	0.60

^¶ For the adjusted analysis, there was only complete data on 138 patients.

Table 4. Risk factors associated with common bile duct stones for patients with incident symptomatic uncomplicated gallstone disease on funen from 1 January 2020 – 1 July 2023.

Covariate	Crude hazard ratio (95% CI) for CBD stones	p-value	Adjusted hazard ratio (95% CI) for CBD stones	p-value
Male gender	1.22 (0.72–2.08)	0.47
Age (10-year increase):	0.89 (0.77–1.03)	0.13
Ethnicity other than Scandinavian	0.81 (0.29–2.25)	0.69
Gallstone characteristics:
Multiple, including sludge	2.51 (1.21–5.20)	0.01	1.90 (0.77–4.65)	0.16
Size (1 mm increase)	0.89 (0.82–0.96)	<0.01	0.89 (0.82–0.97)	<0.01
Body mass index category increase:	1.23 (0.92–1.64)	0.16
Smoking history:
Current	0.54 (0.24–1.24)	0.15
Former	1.03 (0.53–2.01)	0.93
Alcohol consumption:
Less than 14/21 units per week	0.80 (0.44–1.44)	0.46
More than 14/21 units per week	1.02 (0.42–2.51)	0.96
Hypercholesterolemia:	1.14 (0.55–2.35)	0.73
Hormone therapy:	1.00 (0.43–2.32)	0.99
Previous pregnancies:	1.25 (0.57–2.77)	0.58

^¶ For the adjusted analysis, there was only complete data on 138 patients.