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The predictive significance of neutrophil-to-lymphocyte ratio in cholecystitis: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this review was to examine whether neutrophil-to-lymphocyte ratio (NLR) can predict the presence of cholecystitis and distinguish between simple and severe cholecystitis.

Methods

A systematic literature search was performed. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random effects model was used to calculate mean difference (MD) in two situations: (a) no cholecystitis versus cholecystitis and (b) simple versus severe cholecystitis. Receiver operating characteristic (ROC) curve analysis was performed to determine cut-off values of NLR for the above situations.

Results

Ten retrospective studies comprising of 2827 patients were included. Three hundred twenty-seven had no cholecystitis, 2100 had simple cholecystitis and the remaining 400 had severe cholecystitis. NLR was significantly higher in acute cholecystitis compared to “no cholecystitis” (MD = 8.05 (95% CI 7.71–8.38), p < 0.01) and in severe cholecystitis when compared with simple cholecystitis (MD = 3.14 (95% CI 1.26–5.02), p < 0.01). For patients with cholecystitis compared to those without cholecystitis, an NLR cut-off value of 2.98 was identified (AUC = 0.90). Logistic regression analysis confirmed an NLR > 2.9 was an independent predictor of cholecystitis (OR 36.0, p = 0.006). In simple versus severe cholecystitis, an NLR cut-off value of 8.5 was identified (AUC = 0.73). Binary logistic regression analysis suggested an NLR > 8.5 was not an independent predictor of severe cholecystitis (OR 6.5 p = 0.090).

Conclusion

NLR is significantly higher in patients with cholecystitis of any severity compared to patients without cholecystitis. Moreover, NLR can predict acute cholecystitis. However, NLR cannot predict the severity of disease due to inadequately powered studies. Future research is required.

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Authors and Affiliations

  1. Department of General Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK

    Aaron Kler, Adnan Taib & Peter Asaad

  2. Department of General Surgery, Wrexham Maelor Hospital, Wrexham, UK

    Shahab Hajibandeh

  3. Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK

    Shahin Hajibandeh

Authors
  1. Aaron Kler
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  2. Adnan Taib
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  3. Shahab Hajibandeh
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  4. Shahin Hajibandeh
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  5. Peter Asaad
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Contributions

Aaron Kler: Study conception and design, data acquisition, analysis and interpretation of the data, drafting of the manuscript and critical revision of the manuscript. Adnan Taib: Data acquisition and critical revision of the manuscript. Shahab Hajibandeh: Analysis and interpretation of the data, writing the original draft and final approval of the version to be submitted. Shahin Hajibandeh: analysis and interpretation of the data, writing the original draft and final approval of the version to be submitted. Peter Asaad: writing and critical revision of the manuscript.

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Correspondence to Aaron Kler.

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Kler, A., Taib, A., Hajibandeh, S. et al. The predictive significance of neutrophil-to-lymphocyte ratio in cholecystitis: a systematic review and meta-analysis. Langenbecks Arch Surg 407, 927–935 (2022). https://doi.org/10.1007/s00423-021-02350-2

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  • DOI: https://doi.org/10.1007/s00423-021-02350-2

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