The Neutrophil-to-Lymphocyte Ratio as a Simple Tool to Predict Severe Acute Cholecystitis and Mortality

Abstract

Purpose: Acute cholecystitis (AC) is a common cause of the acute abdomen. The present study evaluates whether the Neutrophil-to-Lymphocyte Ratio (NLR) could be a simple and useful predictor tool to discriminate the severity in patients with AC, as well as the mortality associated. Methods: We retrospectively analyzed the database from January 2019 to April 2020. 214 patients were admitted to our center with the diagnosis of AC based on the criteria of the Tokyo 2018 Guidelines. The NLR was calculated in all cases at admission by dividing the absolute neutrophil count between the absolute lymphocyte count. The Receiver Operating Characteristic (ROC) curve analysis was used to identify the optimal value in relation to the severity of AC. Finally, the differences in relation to clinical presentation and mortality according to the chosen NLR cut-off value were investigated. Results: The population of our study comprised 187 patients with non-severe CA (87.4%) and 27 with severe CA (12.6%). The NLR cut-off of 12.48 was able to predict severe AC with 70% sensitivity and 70% specificity. A NLR value ≥ 12.48 was significantly associated with older age (p <0.001), severe AC (p<0.001), less cholecystectomies (p<0.001), more cholecystostomies (p <0.001), higher grades of complications (p<0.05), prolonged hospital-stay (p<0.05) and higher mortality (p <0.05). In the multivariate analysis, NLR>12,48 was a factor independently associated with mortality OR 2.29 (95% CI: 1.20-2.79). Conclusions: In our series, NLR ≥ 12.48 was significantly associated with severe AC and higher mortality.EP258_Table 1Variables and characteristics of patients grouped by NLRNºNLR < 12,48 (n=132)NLR ≥ 12,48 (n=82)p-valueAge68,1 yrs (+/- 36,6)77,3 yrs (+/-26,4)P<0.001Mild AC56 (42,4%)19 (23,2%)P<0.001Moderate AC68 (51,5%)44 (53,7%)Severe AC8 (6,1%)19 (23,2%)Cholecystectomy89 (67,4%)37 (45,1%)P<0.001Cholecystostomy7 (5,3%)18 (22%)P<0.001Clavien-Dindo > II8 (6%)13 (15,9%)P<0.05Mean stay5,8 days7,4 daysP<0.05Mortality4 (3%)9 (11%)P<0.05 Open table in a new tab