Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Predicting Conservative Treatment Failure of Acute Cholecystitis at Debaratana Nakhonratchasima Hospital
Keywords:
Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Neutrophil percentage, Acute cholecystitis, Conservative treatment failureAbstract
Background: Acute cholecystitis is a commonly encountered condition. While early cholecystectomy is the standard treatment, many patients initially receive non-operative management. However, some patients do not respond to treatment and develop complications. Inflammatory markers from laboratory tests, such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), may help predict the risk of treatment failure.
Objective: To evaluate the ability of NLR and PLR to predict conservative treatment failure in patients with acute cholecystitis.
Methods: This retrospective cohort study was conducted in patients with acute cholecystitis who received conservative treatment at Debaratana Nakhonratchasima Hospital between January 1, 2019, and February 28, 2025, totaling 99 patients. Demographic data, clinical features, and laboratory results were collected. NLR and PLR were calculated. Associations were analyzed using chi-square test, t-test, Mann–Whitney U test, and logistic regression analysis. The optimal cut-off point was determined by receiver operating characteristic (ROC) curve analysis.
Results: Among 99 patients, 43 (43.4%) experienced conservative treatment failure. There were no significant differences in age and BMI between the two groups. According to the Tokyo Guideline 2018, the failure group had a higher proportion of moderate-to-severe cases (p-value <0.01). The mean duration of symptoms was significantly longer in the failure group (66.11±53.64 hours vs 36.88±32.84 hours, p-value<0.01). The mean neutrophil percentage was significantly higher (p-value=0.04). NLR > 7.9 showed sensitivity 51.2%, specificity 62.5%, AUC 0.56 (95% CI: 0.46–0.66), Crude OR = 1.74 (95% CI: 0.77–3.91), and Adjusted OR = 12.35 (95% CI: 0.98–154.39, p-value=0.051).PLR > 173.43 showed sensitivity 67.4%, specificity 42.9%, AUC 0.55 (95% CI: 0.45–0.64), Crude OR = 1.55 (95% CI: 0.67–3.55), and Adjusted OR = 5.32 (95% CI: 1.01–28.37, p-value=0.049).
Conclusion: The failure rate of conservative treatment in acute cholecystitis was 43.4%. The neutrophil percentage was significantly different between the success and failure groups. PLR > 173.43 was significantly associated with treatment failure after adjustment (p-value=0.049), while NLR > 7.9 showed a non-significant trend (p-value=0.051). These results suggest that both neutrophil percentage and PLR may play a role in assessing the risk of conservative treatment failure in patients with acute cholecystitis, and further studies are needed for confirmation.
Keywords: Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Neutrophil percentage, Acute cholecystitis, Conservative treatment failure
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