A prospective study to assess the use of preoperative neutrophil to lymphocyte ratio as a predictor of severe cholecystitis

Authors

  • N. Siva Durgesh Department of General surgery, KIMS and RF, Amalapuram, Andhra Pradesh, India
  • V. Viswa Teja Department of General surgery, KIMS and RF, Amalapuram, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20210934

Keywords:

Preoperative, Neutrophil to lymphocyte ratio, Cholecystitis

Abstract

Background: Cholecystitis can be divided into simple and severe cholecystitis. Untreated simple cholecystitis resolves within 7–10 days if it does not progress to more severe cholecystitis. Aims and objectives were to evaluate whether neutrophil-to-lymphocyte ratio can differentiate between simple cholecystitis and severe cholecystitis. To evaluate role of NLR as a prognostic indicator.

Methods: The source of data for our study will be patients admitted in the department of general surgery diagnosed with acute cholecystitis in Konaseema Institute of medical sciences and research foundation, Amalapuram. All patients between 15 to 70 years of age with a clinical diagnosis of acute cholecystitis confirmed with histopathology study.

Results: With an NLR value of 4.35, the sensitivity and specificity were 67% and 87%, respectively. Therefore, we considered 4.35 as the cutoff value, and divided the patient population into two groups: those with preoperative NLR values below 4.35 (n=50) and those with values equal to or greater than 4.35 (n=15). 53.33% of higher NLR group patients had severe cholecystitis compared to only 8 % of patients in lower NLR group (p<0.05).  

Conclusions: It was seen that the patients with cholecystitis can be divided into low risk (NLR<4.35) and high risk (NLR≥4.35) groups for severe cholecystitis as per the NLR value at admission.

References

Ahmad MM, Macon WL: Gangrene of the gallbladder. Am Surg 1983;49(3):155–8.

Shakespear JS, Shaaban AM, Rezvani M. CT findings of acute cholecystitis and its complications. Am J Roentgenol. 2010;194(6):1523-9.

Charalel RA, Jeffrey RB, Shin LK. Complicated cholecystitis: the complementary roles of sonography and computed tomography. Ultrasou Quart. 2011;27(3):161-70.

Bingener J, Stefanidis D, Richards ML, Schwesinger WH, Sirinek KR. Early conversion for gangrenous cholecystitis: impact on outcome. Surgic Endosco Intervent Techniq. 2005;19(8):1139-41.

Wilson AK, Kozol RA, Salwen WA, Manov LJ, Tennenberg SD: Gangrenous cholecystitis in an urban VA hospital. J Surg Res. 1994;56(5):402–4.

Contini S, Corradi D, Busi N, Alessandri L, Pezzarossa A, Scarpignato C. Can gangrenous cholecystitis be prevented? A plea against a ‘wait and see’ attitude. J Clin Gastroenterol. 2004;38:710–6.

Fagan SP, Awad SS, Rahwan K, Hira K, Aoki N, Itani KM et al. Prognostic factors for the development of gangrenous cholecystitis. Am J Surg 2003;186:481–5.

Aydin C, Altaca G, Berber I, Tekin K, Kara M, Titiz I. (2006) Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg 2006;13:155–9.

Goodman DA, Goodman CB, Monk JS. Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis. Am Surg 1995;61:257-9.

Lesie H, Blumgart. Surgery of the Liver , Biliary Tract and Pancreas. 4th Edition, New York; Elsevier; 2006.

Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY: Early laparoscopic cholecystectomy is the appropriate management for acute gangrenous cholecystitis. Am Surg 2011,77(4):401–6.

Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E: Diagnosis and treatment of gallbladder perforation. World J Gastroenterol. 2006;12(48):7832–6

Falor AE, Zobel M, Kaji A, Neville A, De Virgilio C: Admission variables predictive of gangrenous cholecystitis. Am Surg 2012;78(10):1075–8.

Tsushimi T, Matsui N, Takemoto Y, Kurazumi H, Oka K, Seyama A, et al. Early laparoscopic cholecystectomy for acute gangrenous cholecystitis. Surg Laparosc Endosc Percutan Tech 2007;17(1):14–8.

Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg 2010;110:543-7.

Lee SK, Lee SC, Park JW, Kim SJ:The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study. Bio Med Crnt Surg. 2014;14:100.

Downloads

Published

2021-02-25

Issue

Section

Original Research Articles