Neutrophil to lymphocyte ratio in the diagnosis of viscero-visceral cardioneuropathy in patients with gallbladder disorders

Abstract

Summary. Neutrophils to lymphocytes ratio (NLR) reflects the activity of systemic nonspecific inflammation and immune system answer. NLR can be influenced by the change of gallbladder condition. It’s a pity, but the diagnostic and prognostic opportunities of NLR are not properly used in routine clinical practice. The aim of this paper was to estimate the NLR value in the assessment of heart condition in the diagnostics of viscero-visceral cardioneuropathy in dependence of gallbladder condition in patients with cardiorheumatic disorders. We analyzed data of 506 inpatients with cardiorheumatic diseases, which were divided into groups according to gallbladder condition: intact gallbladder; sludge, polips and cholesterosis; various deformations of gallbladder body; gallbladder neck deformations and sonographic signs of past cholecystitis; cholelithiasis; anamnesis of cholecystectomy. It was established that NLR levels, revealed in this study, exceeded the levels of healthy people according to our previous studies (1.8±0.46) and literature data (1.65-1.86). NLR was dependent of gallbladder condition: maximal levels always accompanied pathological changes of the latter. On the background of active inflammatory phase of rheumatic diseases NLR was higher, than in case of stable and acute forms of ischemic heart disease. NLR correlations depended on gallbladder condition, and were the most numerous in case of intact gallbladder. NLR was associated with age, heart rate, acute phase inflammatory markers, parameters of endogenous intoxication, cytolysis and structural heart parameters (sizes of chambers, thicknesses of walls, ejection fraction). Ranking analysis of NLR of all included patients showed that its levels were maximal in case of cholecystitis in anamnesis and in patients after cholecystectomy. All other values can be clearly divided into 2 groups: intact gallbladder plus bent gallbladder body and, apart of it, other pathological conditions (sludge, signs of cholecystitis in anamnesis, cholelithiasis and cholecystectomy in anamnesis). Conclusions: NLR was the highest in case of active inflammatory process in hemorrhagic vasculitis (3.66) and rheumatic fever (3.24) than in the stable ischemic heart disease (2.47) and myocardial infarction (1.85), all р<0.05. Regardless of the disorder, NLR was dependent on the gallbladder condition and reached the maximal values in case of gallbladder changes. Taking into account the big amount of NLR correlations with clinical and laboratory parameters, and the results of instrumental diagnostics methods, we can say that NLR may be used in the diagnostics of viscero-visceral cardioneuropathy.