Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-77440

Prognostic role of systemic inflammatory indices in predicting the severity of acute calculous cholecystitis

Meliha Fýndýk, Ramazan Kýyak, Bahadýr Çaðlar, Suha Serin
Departmant of Emergency Medicine, Faculty of Medicine, Balýkesir Üniversity, Balýkesir, Turkey

BACKGROUND: Acute calculous cholecystitis (ACC) is one of the most common conditions encountered in emergency medicine and surgical practice. Delayed recognition of severe cases can lead to complications such as empyema, gangrene, or perforation, resulting in high morbidity and mortality. While the Tokyo Guidelines provide standardized diagnostic and severity grading criteria, the availability and reliability of imaging may be limited in certain settings. Therefore, there is growing interest in simple and cost-effective biomarkers.

OBJECTIVES: This study aimed to evaluate the diagnostic and prognostic value of complete blood count (CBC)-derived systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte × platelet ratio (NLPR), systemic immune-inflammation index (SII), and multiple inflammatory index (MII), in predicting disease severity in patients with ACC.
METHODS: A total of 160 patients diagnosed with ACC in the emergency department between January 2020 and May 2024 were retrospectively analyzed. Patients with acalculous cholecystitis, cholangitis, choledocholithiasis, incomplete data, or younger than 18 years were excluded. Demographic, clinical, and laboratory findings were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values.
RESULTS: The strongest predictive performance was observed for MII (cut-off = 250,011; sensitivity 76.9%; specificity 78.9%; AUC = 0.770). NLR (cut-off = 8.45) showed 76.9% sensitivity and 68.0% specificity (AUC = 0.755). NLPR (cut-off = 0.027) had 76.9% sensitivity and 54.4% specificity, while SII (cut-off = 2414) achieved 69.2% sensitivity and 72.1% specificity (all p <0.05). All indices were significant predictors of severe ACC.
CONCLUSION: CBC-derived systemic inflammatory indices, particularly MII and NLR, are effective, accessible, and inexpensive markers for predicting the severity of ACC. These parameters may complement clinical assessment and assist in decision-making, especially in situations where imaging is unavailable or inconclusive.

Keywords: severe acute cholecystitis, gallstones, systemic immune-inflammation index, emergency medicine

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Akut taþlý kolesistitin ciddiyetini tahmin etmede sistemik inflamatuvar indekslerin prognostik rolü

Meliha Fýndýk, Ramazan Kýyak, Bahadýr Çaðlar, Suha Serin
Balýkesir Üniversitesi Týp Fakültesi, Acil Týp Ana Bilim Dalý, Balýkesir

AMAÇ: Akut kolesistit, acil týp ve cerrahi kliniklerinde en sýk karþýlaþýlan ve tedavi edilen acil durumlardan biridir. Akut taþlý kolesistit (ATK) olgularýnda inflamasyonun þiddetini ve kapsamýný öngörmede kullanýlabilecek sistemik inflamatuvar parametreleri deðerlendiren çalýþmalar sýnýrlýdýr. Bu çalýþmanýn amacý, nötrofil/lenfosit oraný (NLR), trombosit/lenfosit oraný (PLR), nötrofil/lenfosit × trombosit oraný (NLPR), sistemik immün-inflamasyon indeksi (SII) ve çoklu inflamasyon indeksi (MII) gibi tam kan sayýmý (TKS) kaynaklý parametrelerin ATK’nýn ayýrýcý tanýsý ve þiddetinin belirlenmesindeki tanýsal deðerini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþmaya 1 Ocak 2020–31 Mayýs 2024 tarihleri arasýnda acil servise baþvuran ve genel cerrahi tarafýndan ATK tanýsý doðrulanan 160 hasta dahil edildi. Akut akalkülöz kolesistit, kolanjit, koledokolitiazis tanýsý alan, eksik verisi bulunan ve 18 yaþ altý hastalar çalýþma dýþý býrakýldý. Hastalarýn demografik, klinik, laboratuvar ve görüntüleme bulgularý incelendi; NLR, PLR, NLPR, SII ve MII hesaplandý. Parametrelerin þiddet öngörüsündeki etkinliði ROC analizi ile deðerlendirildi.
BULGULAR: En yüksek prediktif deðer MII’de saptandý (kesme deðeri=250.011; duyarlýlýk %76,9; özgüllük %78,9; AUC=0.770). NLR için 8.45 kesme deðeri %76,9 duyarlýlýk ve %68,0 özgüllük gösterdi. NLPR (cut-off=0.027) %76,9 duyarlýlýk ve %54,4 özgüllük; SII (cut-off=2414) ise %69,2 duyarlýlýk ve %72,1 özgüllük saðladý (tümü p<0.05).
SONUÇ: Sistemik inflamasyon indeksleri, özellikle MII ve NLR, ATK þiddetinin deðerlendirilmesinde etkili, ucuz ve eriþilebilir biyobelirteçlerdir. Bu parametreler, özellikle görüntüleme yöntemlerinin sýnýrlý olduðu durumlarda klinik karar sürecine önemli katký saðlayabilir.

Anahtar Kelimeler: þiddetli akut kolesistit, safra taþý, sistemik immün-inflamasyon indeksi, acil týp

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