Efficacy of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Potential Biomarkers for Severity of Acute Calculous Cholecystitis

Background: Acute calculous cholecystitis is a common presentation requiring surgical management.The decision for the line of treatment depends upon the degree of inflammation and severity of the disease.Therefore, the determination of severity is crucial.The objective of the present study was to assess the utility of Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in determining the severity of disease.Methods: This retrospective study analyzed 120 patient records with confirmed acute calculous cholecystitis admitted between October 2023 and March 2024.Demographic details, clinical history, laboratory investigations, and ultrasound findings were reviewed.Disease severity was graded according to Tokyo Guidelines 2018 (TG18).Operative details, type of surgery (laparoscopic vs open), conversion rates, and perioperative complications were recorded.Results: The mean age was 49.9 years, with a female predominance (71.7%).Most patients presented with Grade II severity.Laparoscopic cholecystectomy was the mainstay (92.5%), with 9% requiring conversion to open surgery, while 7.5% underwent upfront open surgery.A strong positive correlation was noted between NLR and PLR (r=0.88,p<0.001).Mean NLR increased from 3.23 in Grade I to 17.07 in Grade III, while PLR rose from 146.4 to 340.3 across the same grades (p<0.001).Both ratios were significantly higher in patients undergoing open surgery compared to laparoscopic surgery (p=0.004 for NLR; p<0.001 for PLR).No major postoperative complications were observed.Conclusion: NLR and PLR correlate well with the severity of acute calculous cholecystitis and may be used as early biomarkers for predicting disease severity.As they are inexpensive and widely available, they can also aid in guiding the choice of surgical management (laparoscopic vs open surgery) and help reduce unfavourable surgical outcomes.