Diagnostic value of LRG-1 in combination with inflammatory factors for the severity and poor prognosis of acute cholecystitis

Accurate stratification of acute cholecystitis (AC) severity and prognosis remains challenging. Leucine-richα-2-glycoprotein-1 (LRG-1) is an inflammatory biomarker, but its role in assessing AC severity has not been studied. This study aimed to investigate the diagnostic and prognostic value of LRG-1 alone and in combination with inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-10. This case-control study enrolled 60 patients with AC and 30 healthy controls (HCs). Patients were stratified by severity (mild, moderate, and severe). Serum levels of LRG-1, TNF-α, IL-6, and IL-10 were measured using enzyme-linked immunosorbent assay. The diagnostic efficacy for AC severity and poor prognosis was assessed using receiver operating characteristic (ROC) curves. Internal validation of the combined models was performed using 1,000 case-level bootstrap resamples with complete model refitting in each resample. Leave-one-out cross-validation (LOOCV) was performed as a secondary sensitivity analysis. Serum LRG-1, IL-6, IL-10, and TNF-α levels were significantly higher in AC patients than in HCs (all p < 0.05), and their levels increased with severity and showed positive correlations. A combined model (LRG-1 + cytokines) showed superior diagnostic performance for AC (AUC = 0.962, p < 0.001) compared with LRG-1 alone (AUC = 0.830, p < 0.001). This combination model could also differentiate moderate from mild AC (AUC = 0.954, p < 0.001) and severe from moderate AC (AUC = 0.902, p < 0.001). After 1,000-bootstrap optimism correction, the corresponding AUCs of LRG-1 + cytokines were 0.958 (HC vs. AC), 0.934 (mild vs. moderate AC), and 0.848 (moderate vs. severe). Moreover, LRG-1 and IL-10 were associated factors for poor prognosis (both p < 0.05). Their combination predicted prognosis with high accuracy (AUC = 0.960, p < 0.001) and a bootstrap-corrected AUC of 0.945. The combination of LRG-1, TNF-α, IL-6, and IL-10 appears to have diagnostic value for predicting AC severity, while the combination of LRG-1 and IL-10 may contribute to predicting poor prognosis.