Neutrophil–Lymphocyte Ratio, Platelet–Lymphocyte Ratio, and Lymphocyte–Monocyte Ratio in Predicting Systemic Inflammatory Response Syndrome and Sepsis after Percutaneous Nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is a common surgical procedure for removing kidney stones larger than 2 cm. Postoperative complications such as systemic inflammatory response syndrome (SIRS) and sepsis are significant concerns. Biomarkers like neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and lymphocyte–monocyte ratio (LMR) may help to predict these complications. Methods: In this prospective observational study, 100 patients undergoing PCNL were evaluated. Preoperative NLR, PLR, and LMR were calculated from routine blood tests. Stone characteristics and intraoperative factors were recorded. Postoperative SIRS and sepsis were defined using standard criteria. Statistical analyses included univariate and multivariate analyses to identify predictors of SIRS and sepsis. Results: Out of 100 patients, 11% developed SIRS and 4% developed sepsis post-PCNL. Patients with SIRS had significantly lower hemoglobin levels, higher total leukocyte counts, higher NLR and PLR, and lower LMR (p < 0.05). Staghorn stones and longer operative times were also associated with increased risk of SIRS. On multivariate analysis, elevated preoperative TLC, NLR, PLR, and low LMR were independent predictors of SIRS. ROC analysis identified optimal cut-off values for NLR (>2.03), PLR (>110.62), and LMR (<3.23) in predicting SIRS. Conclusion: Preoperative NLR, PLR, and LMR are independent, accessible, and cost-effective biomarkers for early identification of patients at risk of post-PCNL SIRS and sepsis. Patients exceeding these cut-off values should be monitored closely for postoperative infective complications.