Prospective Study to Assess the Use of Preoperative Neutrophil to Lymphocyte Ratio as a Predictor of Severe Cholecystitis

Author(s): Anirudha Sardar, Abu Bakar Siddique, Gazi Shafiqur Rahman, Md. Masud Sattar

Background: Cholecystitis, commonly caused by gallstone obstruction of the cystic duct, leads to gallbladder inflammation. Severe cholecystitis carries a higher risk of complications, including perforation and systemic infection. Early and accurate diagnosis is crucial for timely management.

Aim of the study: This study evaluates the role of the preoperative neutrophil-to-lymphocyte ratio (NLR) as a predictive marker for severe cholecystitis.

Methods: This prospective analytical study was conducted at the department of surgery, Khulna Medical College and hospital, Khulna, Bangladesh from January 2021 to December 2023. A total of 65 patients diagnosed with severe cholecystitis aged 15–65 years were included. Baseline Demographic, clinical, and laboratory data, including NLR were performed. Data analysis was conducted using SPSS, with ≤0.05 considered statistically significant.

Result: Group A (severe cholecystitis) had significantly higher NLR (8.56 ± 2.77), CRP (94.8 ± 63.9 mg/L), and WCC (14.1 ± 9.77 ×10⁹/L) compared to Group B. ROC analysis showed that NLR >4.66 had a sensitivity of 69% and specificity of 85%, with an area under the curve (AUROC) of 0.59 (p < 0.05). Elevated NLR was associated with increased postoperative complications and prolonged hospital stays.

Conclusion: Preoperative NLR serves as a reliable biomarker for predicting severe cholecystitis. Its ability to differentiate between simple and severe cases can guide surgical decisions, optimize patient outcomes, and reduce postoperative complications.