The Role of Preoperative Neutrophil-to-Lymphocyte Ratio and C-reactive Protein in Predicting the Severity of Cholelithiasis With Cholecystitis

Introduction: Acute calculous cholecystitis is a common surgical condition with variable clinical severity. Early identification of severe disease remains challenging. Inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) have been proposed as simple indicators of systemic inflammation and disease severity. The present study aimed to evaluate the association of preoperative NLR and CRP levels with the severity of calculous cholecystitis and their relationship with clinical outcomes. Materials and methods: This prospective observational study was conducted over two years in a tertiary care centre and included 48 patients diagnosed with cholelithiasis with cholecystitis and undergoing laparoscopic cholecystectomy. Preoperative NLR and CRP levels were recorded within 24 hours prior to surgery. Based on intraoperative findings and histopathology, patients were classified into simple, purulent, and gangrenous cholecystitis. Correlation analysis was performed to assess the relationship between inflammatory markers and duration of hospital stay. Results: The mean age was 45.08 ± 13.78 years, with female predominance 30 (62.5%). Simple cholecystitis was most common 23 (47.9%), followed by purulent 15 (31.3%) and gangrenous 10 (20.8%). Median NLR and CRP were 2.67 and 10.55 mg/dl, respectively. Both NLR and CRP increased significantly with worsening severity (p < 0.001). NLR showed a strong positive correlation with CRP (r = 0.641, p = 0.001). NLR (r = 0.427, p = 0.001) and CRP (r = 0.539, p = 0.001) correlated significantly with longer hospital stay. Age and BMI were not significantly associated with severity. Conclusion: Preoperative NLR and CRP levels are significantly associated with the severity of calculous cholecystitis and duration of hospitalization. These readily available biomarkers may serve as useful adjuncts in clinical severity assessment.