A prospective study of preoperative neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and sonological findings in predicting severe cholecystitis

Abstract

Background: The aims and objectives of the study was to assess the utility of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and ultrasound findings to predict severe cholecystitis and to identify an NLR, PLR cut off value that discriminates between simple and severe cholecystitis.Methods: A prospective observational time bound study was conducted with sample size of 100 patients from December 2019 to January 2021. Severe cholecystitis was defined as cholecystitis complicated by secondary changes like haemorrhage, gangrene, emphysema, abscess, perforation, carcinoma. NLR, PLR values were calculated from absolute neutrophil count and absolute lymphocyte count. All patients underwent ultrasound abdomen by the same radiologist and findings were grouped into three categories, luminal, mural and pericholecystic changes. Intraoperative findings, Histopathological examinations were also taken into account. Data was analysed using Statistical package for social sciences (SPSS) Software Version 22. Receiver operating characteristic curve analysis was employed to identify optimal NLR, PLR cut off values and to predict combined accuracy of NLR, PLR and Ultrasound findings to predict severe cholecystitis.Results: In our study, 23% patients had severe cholecystitis. The mean age of patients was 46 years. 65% were females. Presence of calculi and presence of multiple calculi was higher in patients with severe cholecystitis (p value 0.25) calculated using Chi square test. Ultrasound findings of luminal, mural and pericholecystic changes were also found to be higher in severe cholecystitis (p<0.001). Mann whitney test showed mean NLR, PLR higher in severe cholecystitis. A Cut off NLR of 3.75 had a sensitivity of 100%, specificity of 77.92%. Length of hospital stay in patients with severe cholecystitis was longer.Conclusions: NLR of 3.75 is a cut off value to predict severe cholecystitis and prolonged length of hospital stay. Combined Predictive Accuracy of NLR, PLR, Ultrasound findings was 91%. Ultrasonography is a reliable, specific diagnostic tool.