Komplike akut kolesistiti öngörmede preoperatif nötrofil/lenfosit ve trombosit/ lenfosit oranlarý etkilidir

AMAÇ: Akut kolesistit, bazý durumlarda acil ameliyat gerektiren ciddi bir hastalýktýr. Konservatif yaklaþým ve komplikasyon riskini belirlemek için uygun hastalarý belirlemede için uygun maliyetli ve güvenilir bir markera ihtiyaç vardýr. Beyaz kan hücresi, C-reaktif protein gibi diðer parametrelerle birlikte sistemik inflamatuvar belirteçlerin kullanýlmasý, uygun tedavi seçeneðine karar vermede yardýmcý olabilir. Bu çalýþma, komplike akut kolesistit riskini belirlemede nötrofil lenfosit oraný (NLO) ve trombosit lenfosit oranýnýn (PLO) tanýsal deðerini deðerlendirmeyi ve intraoperatif ve patolojik bulgularla karþýlaþtýrmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu çalýþmaya akut kolesistit nedeniyle ameliyat edilen toplam 229 hasta alýndý. Ýntraoperatif ve patolojik olarak komplike 78 olgu ve kontrol grubu 151 olgu idi. Ýki grup iltihap belirteçleri açýsýndan karþýlaþtýrýldý. Daha sonra, kolesistitin ciddiyetine iliþkin NLO ve PLO’nun optimal deðeri belirlemek için ROC karakteristik eðri analizini kullanýldý. NLO ve PLO için kesme deðerine göre klinik semptomlardaki farklýlýklar araþtýrýldý.
BULGULAR: NLO ve PLO düzeyleri komplike grupta anlamlý olarak yüksek bulundu (sýrasýyla, 4.18±4.53 ve 15.23±20.99, 145.34±87.58 ve 251.92±245.93, p<0.01). NLO ve PLO için en iyi kesme deðeri sýrasýyla 5.5 ve 146,90 idi. NLR için duyarlýlýk %80, özgüllük %80.1 idi. PLR için duyarlýlýk %66.7 ve özgüllük %66.2 olarak bulundu.
TARTIÞMA: Sistemik enflamasyon belirteçleri, komplike akut kolesistit riskini tahmin etmek için kullanýlabilir. Özellikle kaynak kýtlýðý olan ortamlarda cerrahi kararlar almak için kullanýlabilecek ucuz araçlardýr.

Pre-operative neutrophil/lymphocyte and platelet/lymphocyte ratios are effective in predicting complicated acute cholecystitis

BACKGROUND: Acute cholecystitis is a severe disease that requires urgent operation in some cases. To select suitable patients for a conservative approach, there is a need for an affordable and reliable marker for determining complication risk. Evaluation of systemic inflammatory markers in combination with other parameters such as white blood cell and the C-reactive protein might help to decide the appropriate treatment option. This study aims to evaluate the diagnostic value of the neutrophil-lymphocyte ratio (NLR) and thrombocyte-lymphocyte ratio (PLR) in determining the risk of complicated acute cholecystitis and to compare with intraoperative and pathological findings.
METHODS: A total of 229 patients operated on for acute cholecystitis were included in this study. Intraoperative and pathologically complicated acute cholecystitis in 78 cases and controls group was 151 cases. The two groups were compared in terms of inflammation markers. Then, we used the receiver operating characteristic curve analysis to determine the optimal value for NLR and PLR concerning the severity of cholecystitis. Then, the differences in clinical symptoms were investigated according to the cutoff value for NLR and PLR.
RESULTS: The NLR and PLR levels were found to be significantly higher in the complicated group (4.18±4.53 vs. 15.23±20.99, 145.34±87.58, and 251.92±245.93, respectively, p<0.01). The best cutoff value for NLR and PLR was 5.5 and 146.90, respectively. Sensitivity for NLR was 80% and specificity was 80.1%. Sensitivity for PLR was 66.7% and specificity was 66.2%.
CONCLUSION: Systemic inflammation markers can be used to predict the risk of complicated acute cholecystitis. They are inex-pensive tools that can be used to make surgical decisions, especially in resource scarce environments.