The predictive significance of neutrophil-to-lymphocyte ratio in cholecystitis: a systematic review and meta-analysis

Neutrophil percentage-to-albumin ratio as a predictor of conservative treatment failure in acute cholecystitis: a retrospective cohort study

BACKGROUND

While early laparoscopic cholecystectomy is the standard treatment for acute cholecystitis, conservative management remains necessary in specific scenarios such as high-risk patients or resource-limited settings. This study evaluated the predictive value of neutrophil percentage-to-albumin ratio (NPAR), a biomarker derived from routine laboratory tests, alongside established inflammatory markers and clinical parameters in identifying patients at risk of conservative treatment failure.

METHODS

In this retrospective cohort study at 2 tertiary centers (2020-2023), we analyzed 508 patients with acute cholecystitis who received conservative management. The study period coincided with the COVID-19 pandemic when healthcare resource constraints led to increased utilization of conservative management. Using admission laboratory data, we calculated NPAR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and assessed Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists Physical Status (ASA-PS) classification. Receiver operating characteristic analysis and logistic regression were performed to evaluate their predictive value.

RESULTS

Conservative treatment failed in 107 patients (21.1%). Risk assessment showed higher proportions of CCI ≥ 6 (32.7% vs. 22.9%; P =.008) and ASA-PS class III-IV (16.8% vs. 8.0%; P =.002) in the failed treatment group. NPAR demonstrated superior predictive performance (area under curve, 0.906 [95% CI, 0.867-0.944]) compared with NLR (0.810 [0.765-0.855]) and PLR (0.614 [0.554-0.673]). The optimal NPAR cutoff value of 21.5 showed sensitivity of 88.8% and specificity of 84.8%. In multivariable analysis, NPAR > 21.5 emerged as the strongest independent predictor (adjusted odds ratio, 19.876 [95% CI, 8.934-42.651]; P <.001), followed by fever > 37.8 °C (2.845 [1.476-5.483]; P =.002) and leukocytosis (2.234 [1.112-4.485]; P =.024). Most treatment failures (77.6%) occurred within 48 h, requiring emergency surgery (57.9%), percutaneous drainage (37.4%), or endoscopic interventions (4.7%).

CONCLUSIONS

NPAR, combined with fever and leukocytosis, provides a practical and cost-effective framework for predicting conservative treatment failure in acute cholecystitis using routine laboratory tests. Although our study was conducted during the COVID-19 pandemic, these findings remain valuable for any clinical setting where conservative treatment is considered. The 48-hour window for most treatment failures provides a practical timeframe for clinical monitoring and intervention decisions.

Inflammatory burden index (IBI) and body roundness index (BRI) in gallstone risk prediction: insights from NHANES 2017-2020

BACKGROUND

The Inflammatory Load Index (IBI) and Body Roundness Index (BRI) were employed to evaluate the systemic inflammatory status and body fat. This study aims to elucidate the association between IBI and the prevalence of gallstones, as well as to analyze the mediating role of BRI in this association.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) (2017-2020) were utilized in our cross-sectional study. A total of 2598 participants aged ≥ 20 years were enrolled. The Boruta algorithm, a supervised classification feature selection method, is leveraged to identify the confounding variables most strongly associated with the prevalence of gallstones. Weighted multivariate logistic regression, restricted cubic splines (RCS), and subgroup analyses were employed to investigate the association between IBI and gallstones, assess the presence of a linear association, and evaluate the effect of IBI on gallstone risk across different populations. Finally, the mediating effect of BRI was examined.

RESULTS

In the fully adjusted model, when IBI was in the highest tertile, each unit increase in IBI (corresponding to an increase of 1 in the natural logarithm of IBI) was linked to a 110.8% higher prevalence of gallstones (OR = 2.108, 95% CI: 1.109-4.005; P = 0.028). The odds ratio for gallstones increased with higher IBI levels across unadjusted, partially adjusted, and fully adjusted models (P for trend < 0.05). This positive association was confirmed to be linear by the RCS curve (P for nonlinear = 0.887). Subgroup analysis indicated that the risk of gallstones was significantly elevated in individuals aged ≥ 60, females, and those with a Poverty-to-Income Ratio (PIR) ≥ 2 (P < 0.05). Mediation analysis revealed that IBI had a significant indirect effect on gallstone prevalence through BRI, with an effect size of 0.0129 (95% CI: 0.0121-0.0136; P < 0.001), and the mediation contributed to 33.24% of the total effect.

CONCLUSIONS

This study demonstrates a significant linear positive relation of IBI to gallstone prevalence. Furthermore, BRI mediates the effect of IBI on gallstone risk. These findings provide a more precise inflammatory marker for gallstone prevention and treatment.

TRIAL REGISTRATION

Not applicable.

Predicting severity of inpatient acute cholangitis: combined neutrophil-to-lymphocyte ratio and prognostic nutritional index

The indicators for rapid assessment of the severity of acute cholangitis remain highly debated. Therefore, this study aimed to evaluate the efficacy of various inflammatory and immune-nutritional markers in predicting the severity of acute cholangitis. The prognostic roles of the following markers were investigated: Systemic Immune-Inflammatory Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Albumin (Alb), and Prognostic Nutritional Index (PNI). A total of 139 patients with acute cholangitis were included in the study. The inflammatory and immune-nutritional markers with better predictive efficacy were selected to construct a combined predictive score. According to the survival ROC curve analysis, the combined NLR and PNI score, termed PNS, demonstrated the best prognostic performance with an AUC of 0.853. Multivariable survival analysis identified the following independent prognostic factors: PNS (p = 0.010) and Prothrombin Time (PT) (p = 0.003). The results indicate that PNS = 2 is associated with a higher incidence of severe cholangitis.

Association between Neutrophil-to-high-density lipoprotein-cholesterol ratio and gallstones: insights from the national health and nutrition examination survey (2017-2020)

BACKGROUND

Inflammatory responses and lipid metabolism make vital impacts on the development of gallstones. This study investigated the relationship between gallstone disease (GSD) and the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) in American patients with gallstones.

METHODS

The data analyzed were sourced from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) and comprised of participants with complete data on GSD and NHR. The relationship between NHR and GSD was evaluated with weighted multivariable logistic regression analysis. Additionally, subset analyses, interaction tests, smoothed curve fitting, and threshold effect analyses were conducted.

RESULTS

Among the 7894 participants analyzed in this study, the prevalence of GSD was 10.98%, and the average NHR value was 3.41 ± 0.06. The fully adjusted multivariable logistic regression results demonstrated an obvious positive association between NHR and the likelihood of GSD (OR = 1.09, 95% CI: 1.01, 1.16; P = 0.0197). Consistency of this association was confirmed through subset analyses and interaction tests across various subgroups, including those categorized by smoking status and asthma. Furthermore, smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship with a threshold of 2.86.

CONCLUSIONS

NHR shows a positive relationship to an increased likelihood of GSD among Americans. It can act as an easy and cost-effective tool for the early detection and management of individuals at risk for GSD.

The Role of Different Systemic Inflammatory Indexes Derived from Complete Blood Count in Differentiating Acute from Chronic Calculus Cholecystitis and Predicting Its Severity

Purpose

This study aimed to evaluate the diagnostic value of the different Complete blood count-derived systemic inflammation indexes, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and neutrophil to lymphocyte × platelet ratio (NLPR) in differential diagnosing the chronic calculus cholecystitis (CCC) and the acute calculus cholecystitis (ACC), as well as determining the severity of ACC.

Patients and Methods

105 CCC and 88 ACC patients were enrolled. NLR, PLR, SII, and NLPR were evaluated in both cohorts as well as in different severity levels of ACC. The severity of ACC was determined based on the Tokyo Guidelines. Receiver operating characteristic (ROC) curve and Univariate/multivariate regression analyses were conducted.

Results

The levels of NLR, PLR, SII, and NLPR were significantly higher in the ACC group compared to the CCC group. The optimal cutoff values for NLR, PLR, SII, and NLPR were determined to be 3.89, 144.7, 896.8, and 0.031 respectively. NLR>3.89 demonstrates the highest predictive capability with an AUC of 0.801 and a sensitivity of 72.73%. Multivariate analysis showed that NLR>3.89 (OR: 4.169, p = 0.004) and NLPR>0.031 (OR: 4.304, p = 0.005) were dominant in distinguishing ACC from CCC. In ACC patients, the levels of NLR, SII, and NLPR were significantly higher in the Moderate to Severe-degree ACC (MS-ACC) group than in Mild-Degree ACC (M-ACC). NLPR > 0.044 exhibited the highest predictive ability with an AUC of 0.778 and a specificity of 91.67%. Multivariate analysis showed that NLR>6.399 (OR: 10.308, p = 0.000) was a possible independent prognostic factor for accessing the severity of ACC.

Conclusion

Systemic inflammation indexes can be useful in predicting the risk of ACC and MS-ACC. NLR demonstrates the best distinguishing power and sensitivity for distinguishing ACC from CCC, while NLPR shows the best predictive power and specificity for predicting the severity of ACC.

Clinical Significance of the Neutrophil–Lymphocyte Ratio as an Early Predictive Marker for Adverse Outcomes in Patients with Acute Cholangitis

Background and objectives: Acute cholangitis can be life-threatening if not recognized early. We investigated the predictive value of the neutrophil–lymphocyte ratio (NLR) in acute cholangitis. Materials and Methods: We retrospectively evaluated 206 patients with acute cholangitis who underwent biliary drainage. The severity of acute cholangitis was graded according to the Tokyo 2018 guideline. Patients were dichotomized according to the acute cholangitis severity (mild/moderate vs. severe), the presence of shock requiring a vasopressor/inotrope, and blood culture positivity. The baseline NLR, white blood cell (WBC) count, and C-reactive protein (CRP) levels were compared between groups. Results: The severity of acute cholangitis was graded as mild, moderate, or severe in 71 (34.5%), 107 (51.9%), and 28 (13.6%) patients, respectively. Ten patients (4.8%) developed shock. Positive blood culture (n = 50) was observed more frequently in severe acute cholangitis (67.9% vs. 17.4%, p < 0.001). The NLR was significantly higher in patients with severe cholangitis, shock, and positive blood culture. The area under the curve (AUC) for the NLR, WBC, and CRP for severe acute cholangitis was 0.87, 0.73, and 0.74, respectively. The AUC for the NLR, WBC, and CRP for shock was 0.81, 0.64, and 0.67, respectively. The AUC for the NLR, WBC, and CRP for positive blood culture was 0.76, 0.64, and 0.61, respectively; the NLR had greater power to predict disease severity, shock, and positive blood culture. The optimal cut-off value of the baseline NLR for the prediction of severe acute cholangitis, shock, and positive blood culture was 15.24 (sensitivity, 85%; specificity, 79%), 15.54 (sensitivity, 80%; specificity, 73%), and 12.35 (sensitivity, 72%; specificity, 70%), respectively. The sequential NLR values from admission to 2 days after admission were significantly higher in patients with severe cholangitis and shock. Conclusions: An elevated NLR correlates with severe acute cholangitis, shock, and positive blood culture. Serial NLR can track the clinical course of acute cholangitis.