Neutrophil to lymphocyte ratio in predicting complications and prognosis in patients with acute cholangitis

Abstract

Introduction: Acute cholangitis belongs to urgent conditions in surgery, which are accompanied by high mortality and require clear diagnosis and immediate treatment. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in hepatobiliary surgery.Aim of the study: to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after hepatobiliary surgery.Methods: We evaluated 229 patients with acute cholangitis who underwent biliary drainage. The severity of acute cholangitis was graded according to the Tokyo 2018 guideline. Patients were dichotomized according to the acute cholangitis severity (mild/moderate vs. severe), and blood culture positivity. The baseline NLR, white blood cell (WBC) count, and C-reactive protein (CRP) levels were compared between groups.Results: Of the 229 acute cholangitis patients analyzed, 83 (36.3%) had mild, 111 (48.5%) had moderate, and 35 (15.2%) had severe acute cholangitis. Positive blood culture (n = 114) was more frequently observed in the severe acute cholangitis group than the mild/moderate cholangitis group (83% vs. 43%, p < 0.001). The NLR was significantly higher in patients with severe cholangitis, shock, and positive blood culture. Conclusion: The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in acute cholangitis. The high predictive value of CRP and PCT, as well as high availability and low cost of performing a clinical blood test, make NLR a more promising test in clinical practice.