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Visfatin correlates with inflammation and its levels in peripheral blood are associated with some inflammatory diseases. This study aimed to assess the relationship between plasma visfatin levels and conversion of laparoscopic cholecystectomy to open surgery in acute cholecystitis. One hundred and forty-six acute cholecystitis patients and 146 sex- and age-matched healthy controls were recruited and their plasma visfatin levels were determined using an enzyme immunoassay. 17 patients (11.6%) underwent conversion. Plasma visfatin levels were statistically significantly elevated in all patients (97.2 ± 41.8 ng/mL), those with (161.4 ± 71.3 ng/mL) or without conversion (88.7 ± 26.9 ng/mL), compared to controls (40.3 ± 13.3 ng/mL, all P < 0.001). A linear regression analysis showed that plasma visfatin levels were positively associated with plasma C-reactive protein levels ( t = 0.510, P < 0.001). A logistic-regression analysis showed that age [odds ratio (OR) 1.160, 95% confidence interval (CI) 1.011–1.332, P = 0.035] and plasma visfatin levels (OR 1.035, 95% CI 1.005–1.066, P = 0.022) appeared to be the independent predictors of conversion. A receiver operating characteristic curve analysis found that plasma visfatin levels predicted conversion with high area under curve (AUC) (AUC, 850; 95% CI, 0.781–0.903). The AUC of the visfatin concentration was similar to that of age (AUC, 0.738; 95% CI, 0.659–0.807) ( P = 0.188). Visfatin improved the AUC of age to 0.914 (95% CI, 0.856–0.954) ( P = 0.011) using a combined logistic-regression model. Thus, high plasma levels of visfatin are associated with systemic inflammation, and may independently predict conversion of laparoscopic cholecystectomy to open surgery in acute cholecystitis. [ABSTRACT FROM AUTHOR]