Diagnostic Role of Neutrophil–Lymphocyte Ratio as Marker of Severity in Patients with Acute Cholangitis

Uzziel Romar S. Alonzo, MD
East Avenue Medical Center

Significance: In a setting where resources are limited, identifying patients who have severe cholangitis in a fast and economic manner is of advantage. Patients with severe cholangitis is a priority to abrupt biliary drainage, due to its high mortality. We investigated then the diagnostic value of neutrophil-lymphocyte ratio (NLR) in identifying patients with non-severe and severe cholangitis. Cut-off level of NLR which will differentiate the two groups was also determined.

Methodology: We retrospectively evaluated 108 patients from January 2021 to December 2023 using simple random sampling. Inclusion criteria: 1). Patients with Charcot’s Triad, 2). Elevated Bilirubin and Alkaline Phosphatase, 3). Presence of ectasia in an imaging. Exclusion criteria: 1) Less than 18 years old, 2) Had concurrent inflammatory diseases such as acute pancreatitis, liver abscess, pneumonia, or acute cholecystitis. Using the formula to estimate the difference of 2 proportions, a minimum of 40 samples per group (non-severe and severe) were collected. Descriptive statistical analyses were used for the demographic profile of respondents using SPSS version 23.0. Pearson r Moment of Correlation was used to determine the relationship of NLR values and Severity of Cholangitis thru Tokyo Grading 2018. Receiver Operating Characteristic curve was used to determine the specificity and sensitivity of NLR in determining Severe Acute Cholangitis. Area Under Curve (AUC) was used to quantify the overall ability of the test to discriminate the severity of the disease.

Results: The mean NLR of patients classified as non-severe was 8.27 ± 10.23. While the mean NLR of patients categorized as severe was 29.08 ± 20.00. A significant relationship (0.004) of NLR values and Tokyo Severity Grading 2018 of Acute Cholangitis was noted at significance level of 0.01. NLR is a good model of predicting cholangitis given an AUC of 0.781. Using the cutoff value of 13.7 the sensitivity and specificity in predicting severe cholangitis using NLR level were 47.5% and 82.4%, respectively.

Conclusion: NLR has an ability to detect severe cases of Cholangitis, comparable to Tokyo Severity Grading of Acute Cholangitis 2018. The higher the NLR is the higher the possibility of having a severe cholangitis.

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