Glutamate Dehydrogenase as a Superior Biomarker for Choledocholithiasis Risk Stratification

Background and AimsCholedocholithiasis (CDL) is a common condition that can lead to serious complications, requiring effective risk stratification for timely intervention. While current guidelines use clinical predictors, imaging, and laboratory markers for risk assessment, the role of glutamate dehydrogenase (GLDH) in CDL remains poorly understood. This study aims to evaluate its potential as a clinical biomarker for identifying patients with CDL. MethodsThis single-center cohort study identified 23,103 patients who presented to the emergency department of the University Medical Center Hamburg-Eppendorf and underwent routine abdominal laboratory testing between May 2021 and December 2023. Patients were classified into CDL and other diagnoses. To assess the predictive value of age, sex and laboratory markers for CDL, we developed a random forest machine learning model, conducted a backward stepwise logistic regression and performed receiver operating characteristic (ROC) analysis. Results152 patients were diagnosed with CDL and 22,951 with other diagnoses. In the random forest machine learning model, GLDH emerged as the most significant feature for predicting CDL. ROC analysis revealed that GLDH had the highest area under the curve of 0.93 among laboratory markers. At the upper limit of normal, GLDH demonstrated the best sensitivity (92%) compared to aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin. High GLDH levels exceeding 150 U/L demonstrate the highest specificity (99%) for CDL, outperforming AST, ALT and bilirubin. ConclusionGLDH outperforms AST, ALT and bilirubin as a screening and predictive marker for CDL, supporting its inclusion in clinical guidelines for risk stratification.