Can NLR be Used in Discriminating Simple and Severe Cholecystitis in Emergency Department Admission?

Abstract

INTRODUCTION: Aim: Cholecystitis is a common surgical emergency case, and the progress of simple cholecystitis to severe cholecystitis results in preoperative inflammatory and metabolic complications and a longer hospital stay. We aimed to determine whether the neutrophil-lymphocyte ratio (NLR) could help discriminate between simple and severe cholecystitis in emergency department (ED) admissions. METHODS: Materials and Methods: All patients who were aged 18 or older, were diagnosed with cholecystitis, and presented to ED were included in our retrospective study. Blood laboratory values of patients who were diagnosed with cholecystitis in ED and whose preoperative diagnosis was confirmed were taken. Patients with secondary changes associated with cholecystitis, such as gangrenous cholecystitis and gallbladder perforation, were included in the severe cholecystitis group. RESULTS: Results: The study consisted of 54 patients, including 45 (83.33%) with simple cholecystitis and 9 (16.67%) with severe cholecystitis. Of the 54 patients, 28 (51.85%) were male, 26 (48.15%) were female, and the median age was 71 years (minimum-maximum: 27-94). NLR was found significantly higher in the severe cholecystitis group compared to the simple cholecystitis group (p <0.001). Besides, there was a significant difference between the two groups in terms of CRP, WBC, neutrophil, and lymphocyte values. DISCUSSION AND CONCLUSION: Conclusion: Early discrimination of simple and severe cholecystitis in patients presenting to the emergency department with right upper quadrant pain is important in terms of patient management. We think it may be useful to utilize the NLR ratio to discriminate between simple and severe cholecystitis.

Keywords

• simple cholecystitis
• severe cholecystitis
• neutrophil-lymphocyte ratio