Comparison of the Role of High Neutrophil to Lymphocyte Ratio with Leukocytosis in Diagnosing Acute Cholecystitis

Authors

  • Muhammad Umair Khalid Department of General Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Muhammad Ayub Ashraf Department of General Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Azka Zainab Department of Radiology, Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Zaka Ur Rehman Department of General Surgery, Nishtar College and Hospital, Multan Pakistan
  • Muhammad Sufyan Department of General Surgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Fizza Fatima Department of General Surgery, Nishtar College and Hospital, Multan Pakistan

DOI:

https://doi.org/10.51253/pafmj.v73i6.8895

Keywords:

Acute cholecystitis, Leukocytosis, Neutrophil to lymphocyte ratio

Abstract

Objective: To compare the diagnostic accuracy of high neutrophil-to-lymphocyte ratio levels versus leukocytosis in detecting acute cholecystitis.

Study Design: Cross-sectional validation study.

Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Dec
2021 to Jun 2022.

Methodology: One hundred eighteen patients with the clinical diagnosis of acute cholecystitis were included in the study.
Patients with neoplastic or autoimmune disease or ongoing chronic infections were excluded. All patients underwent a test for complete blood counts to document the total leucocyte count and the neutrophil-to-lymphocyte ratio. The diagnosis of acute cholecystitis was confirmed on contrast-enhanced computed tomography abdomen.

Results: The study sample had a mean age of 46.56±13.78 years, with 81(68.6%) females. The total leucocyte count had a sensitivity of 67.1%, a specificity of 73.3% and a diagnostic accuracy of 69.5% for predicting the presence of acute cholecystitis. In contrast, the neutrophil to lymphocyte ratio, with a cut-off of 3, had a sensitivity of 73.7%, a specificity of 68.9% and a diagnostic accuracy of 71.2% in predicting the presence of acute cholecystitis using contrast-enhanced computed tomography as a gold standard.

Conclusion: Both total leucocyte count and the neutrophil to lymphocyte ratio were equally effective for diagnosing acute
cholecystitis in clinically diagnosed patients.

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References

Schuld J, Glanemann M. Acute Cholecystitis. Viszeralmedizin

; 31(3): 163-165. https://doi.org/10.1159/000431275.

Popa CC, Badiu DC, Rusu OC, Grigorean VT, Neagu SI, Strugaru

CR, et al. Mortality prognostic factors in acute pancreatitis. J Med

Life. 2016; 9(4): 413-418.

Jones MW, Genova R, O'Rourke MC. Acute Cholecystitis. In:

StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.

Halpin V. Acute cholecystitis. BMJ Clin Evid 2014; 2014(1): 0411.

Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S,

Boerna D, et al. 2020 World Society of Emergency Surgery

updated guidelines for the diagnosis and treatment of acute

calculus cholecystitis. World J Emerg Surg 2020; 15(1): 61.

https://doi.org/10.1186/s13017-020-00336-x.

Schiappacasse G, Soffia P, Silva C, Villacrés F. Computed

tomography imaging of complications of acute cholecystitis.

Indian J Radiol Imaging 2018; 28(2): 195-199.

https://doi.org/10.4103%2Fijri.IJRI_316_17.

Algin A, Gulacti U, Inan İ, Erdogan MO, Colak S et al.

Relationship between serum Pentraxin 3 and pro-adrenomedullin levels with acute cholecystitis. Am J Emerg Med 2019;

(7): 1268-1272. https://doi.org/10.1016/j.ajem.2018.09.024.

Mok KW, Reddy R, Wood F, Turner P, Ward JB, Pursnani KG, et

al. Is C-reactive protein a useful adjunct in selecting patients for

emergency cholecystectomy by predicting severe/gangrenous

cholecystitis? Int J Surg 2014; 12(7): 649-653.

https://doi.org/10.1016/j.ijsu.2014.05.040.

Gürağaç A, Demirer Z. The neutrophil-to-lymphocyte ratio in

clinical practice. Can Urol Assoc J 2016; 10(3-4): 141.

https://doi.org/10.5489%2Fcuaj.3587.

Mahmood F, Akingboye A, Malam Y, Thakkar M, Jambulingam

P. Complicated Acute Cholecystitis: The Role of C-Reactive

Protein and Neutrophil-Lymphocyte Ratio as Predictive Markers

of Severity. Cureus 2021; 13(2): e13592.

https://doi.org/10.7759/cureus.13592.

Lee SK, Lee SC, Park JW, Kim SJ. The utility of the preoperative

neutrophil-to-lymphocyte ratio in predicting severe cholecystitis:

a retrospective cohort study. BMC Surg 2014; 14(1): 100.

https://doi.org/10.1186/1471-2482-14-100.

Makatini GM, Mewa Kinoo S, Singh B. An audit of interval

cholecystectomy for acute cholecystitis in a low resource

healthcare system. S Afr J Surg 2020; 58(1): 10-13.

Mohammuddunnobi M, Jahan T, Al-Amin A, Jahan S, Debnath

PR. Results of Laparoscopic Cholecystectomy in Acute Cholecystitis in Diabetic Patients: A Study with 50 Cases. Mymensingh

Med J 2021; 30(1): 135-142.

Novacek G. Gender and gallstone disease. Wien Med

Wochenschr 2006; 156(19-20): 527-533.

http://doi.org/10.1007/s10354-006-0346-x.

Yang WS, Chang YC, Chang CH, Wu LC, Wang JL, Lin HH, et al.

The Association between Body Mass Index and the Risk of

Hospitalization and Mortality due to Infection: A Prospective

Cohort Study. Open Forum Infect Dis 2020; 8(1): ofaa545.

https://doi.org/10.1093/ofid/ofaa545.

Rincon JE, Rasane RK, Aldana JA, Zhang CX, Fonseca RA, Zhang

Q, et al. Acute Acalculous Cholecystitis-Associated Bacteremia

Has Worse Outcome. Surg Infect (Larchmt) 2021; 22(2): 182-186.

https://doi.org/10.1089/sur.2019.297.

Beliaev AM, Marshall RJ, Booth M. C-reactive protein has a

better discriminative power than white cell count in the

diagnosis of acute cholecystitis. J Surg Res 2015; 198(1): 66-72.

https://doi.org/10.1016/j.jss.2015.05.005.

Rizvi N, Khan K, Shaikh BT. Gender: shaping personality, lives

and health of women in Pakistan. BMC Women Health 2014;

(1): 53. https://doi.org/10.1186/1472-6874-14-53.

Mahmood F, Akingboye A, Malam Y, Thakkar M, Jambulingam

P. Complicated Acute Cholecystitis: The Role of C-Reactive

Protein and Neutrophil-Lymphocyte Ratio as Predictive Markers

of Severity. Cureus 2021; 13(2): e13592.

https://doi.org/10.7759/cureus.13592.

Aftab ML, Nasir M, Hassan NU, Farooq U. Role of Neutrophil to

Lymphocyte Ratio in Diagnosis of Cholecystitis. Pak J Med

Health Sci 2019 ; 20(4): 989-991.

Micić D, Stanković S, Lalić N, Đukić V, Polovina S. Prognostic

Value of Preoperative Neutrophil-to-lymphocyte Ratio for

Prediction of Severe Cholecystitis. J Med Biochem 2018; 37(2):

-127. https://doi.org/10.1515%2Fjomb-2017-0063.

Ay S, Tanrikulu CS. Diagnostic utility of neutrophil lymphocyte

ratio in acute complicated cholecystitis. Ann Med Res. 2019;

(2): 135-8. https://doi.org/10.5455/annalsmedres.2018.09.198

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Published

30-12-2023

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Section

Original Articles

How to Cite

1.
Khalid MU, Ashraf MA, Zainab A, Zaka Ur Rehman, Muhammad Sufyan, Fizza Fatima. Comparison of the Role of High Neutrophil to Lymphocyte Ratio with Leukocytosis in Diagnosing Acute Cholecystitis. Pak Armed Forces Med J [Internet]. 2023 Dec. 30 [cited 2024 Dec. 27];73(6):1737-40. Available from: https://pafmj.org/PAFMJ/article/view/8895