The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study

Abstract

BackgroundTo evaluate whether the neutrophil-to-lymphocyte ratio (NLR), as a prognostic indicator, in patients can differentiate between simple and severe cholecystitis.MethodsA database of 632 patients who underwent cholecystectomy due to cholecystitis during approximately a seven-year span in a single institution was evaluated. Severe cholecystitis was defined when the cholecystitis was complicated by secondary changes, including hemorrhage, gangrene, emphysema, and perforation. The NLR was calculated at admission as the absolute neutrophil count divided by the absolute lymphocyte count. We used receiver operating characteristic curve analysis to identify the optimal value for the NLR in relation to the severity of cholecystitis. Thereafter, the differences in clinical manifestations according to the NLR cut-off value were investigated.ResultsOur study population comprised 503 patients with simple cholecystitis (79.6%) and 129 patients with severe cholecystitis (20.4%). The NLR of 3.0 could predict severe cholecystitis with 70.5% sensitivity and 70.0% specificity. A higher NLR (≥3.0) was significantly associated with older age (p =0.001), male gender (p =0.001), admission via the emergency department (p <0.001), longer operation time (p <0.001), higher incidence of postoperative complications (p =0.056), and prolonged length of hospital stay (LOS) (p <0.001). Multivariate analysis found that patient age ≥50 years (odds ratio [OR]: 2.312, 95% confidence interval [CI]: 1.472–3.630, p <0.001), preoperative NLR ≥3.0 (OR: 1.876, 95% CI: 1.246–2.825, p =0.003), and admission via the emergency department (OR: 1.764, 95% CI: 1.170–2.660, p =0.007) were independent factors associated with prolonged LOS.ConclusionsNLR ≥3.0 was significantly associated with severe cholecystitis and prolonged LOS in patients undergoing cholecystectomy. Therefore, preoperative NLR in patients undergoing cholecystits due to cholecystitis seemed to be a useful surrogate marker for severe cholecystitis.

Diagnostic utility of the neutrophil-to-lymphocyte ratio in patients with acute mesenteric ischemia: A retrospective cohort study

“…[8] NLR is increasingly used to predict the survival of patients with malignancies, coronary artery disease, acute appendicitis, acute cholecystitis, acute pancreatitis, and community-acquired infections. [7] Lee et al [21] found that preoperative NLR accurately predicted the development of severe cholecystitis. Yu et al [22] found that preoperative NLR was prognostic for gastric cancer patients.…”

The Utility of Neutrophil-to-Lymphocyte Ratio as a Severity Predictor of Acute Appendicitis, Length of Hospital Stay and Postoperative Complication Rates

“…Alternatively, total WCC and platelet count have been advocated as indicators of severity of appendicitis, but with varying success [22] . Evidence to date demonstrates that NLR is a good marker of subclinical inflammation, with studies showing that it correlates with the severity of acute inflammatory bowel disease and acute cholecystitis [10,12,13] . Additionally, recent studies have observed that NLR correlates with colorectal cancer stage and oncological outcome and is currently being considered as a biomarker [15,16] .…”

“…Ideally, we advocate that these patients should be brought back earlier to the outpatient department for review. Recently, a study examining the role of NLR in forecasting the clinical course of acute cholecystitis found that it had predictive qualities in estimating LOS [10] . Our study also noted that NLR was indicative of total LOS, with severe appendicitis having a median of 1 extra in-patient day.…”

“…Several randomized controlled trials have shown that antibiotics can be as efficacious as surgery, with lower overall complication rates [10,11] . However, to select patients suitable for a conservative management approach, there is a need to better delineate the severity of acute appendicitis at the time of admission itself.…”

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

“…[3–5] Surgical interventions may be needed to manage diabetic foot infections; these vary from minor to major interventions, such as debridement or amputation. [6,7] The rate of lower extremity amputation (LEA) among patients with diabetes may be as high as 70%, and the most frequent cause of nontraumatic LEA is a diabetic foot ulcer. [8–10] …”