A prospective study to evaluate use Of neutrophil to lymphocyte ratio (nlr) as a marker for severe acute Cholecystitis

Abstract

BACKGROUND: Acute cholecystitis is one of the most common afflictions of the gastrointestinal system presenting to OPD or emergency department. Reported incidence of cholelithiasis is 10% to 15%. Annually, symptom development in asymptomatic people ranges from 1% to 2%. Delayed identification of acute cholecystitis can lead to complications (hemorrhage, empyema, gangrene, perforation of gallbladder, emphysema, adhesions, challenging dissection) thus leading to increased morbidity. Overall reported mortality is 1%. A new, inexpensive and simple predictor of severe acute Cholecystitis is needed for stratification of patients for urgent biliary drainage, close monitoring, and intensive care unit (ICU) care. Thus, Neutrophil Lymphocyte ratio is being proposed as a potential prognostic biomarker for prediction of severe acute cholecystitis. AIMS, OBJECTIVES: 1. To evaluate the utility of the Neutrophil Lymphocyte Ratio as a prognostic indicator in patients with acute cholecystitis, and to identify a relevant ratio value that discriminates between mild, moderate and severe acute cholecystitis. 2. To evaluate and compare the discriminative powers of the neutrophil-to- lymphocyte ratio with White Cell Counts, CRP and radiological modalities (USG or CT) in diagnosing severe acute cholecystitis with help of Tokyo guidelines.