Prognostic role of systemic inflammatory indices in predicting the severity of acute calculous cholecystitis

Acute calculous cholecystitis (ACC) is one of the most common conditions encountered in emergency medicine and surgical practice. Delayed recognition of severe cases can lead to complications such as empyema, gangrene, or perforation, resulting in high morbidity and mortality. While the Tokyo Guidelines provide standardized diagnostic and severity grading criteria, the availability and reliability of imaging may be limited in certain settings. Therefore, there is growing interest in simple and cost-effective biomarkers. This study aimed to evaluate the diagnostic and prognostic value of complete blood count-derived (CBC-derived) systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte × platelet ratio (NLPR), systemic immune-inflammation index (SII), and multiple inflammatory index (MII), in predicting disease severity in patients with ACC.

A total of 160 patients diagnosed with ACC in the emergency department between January 2020 and May 2024 were retrospectively analyzed. Patients with acalculous cholecystitis, cholangitis, choledocholithiasis, incomplete data, or age younger than 18 years were excluded. Demographic, clinical, and laboratory findings were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values.

The strongest predictive performance was observed for MII (cut-off=250,011; sensitivity 76.9%; specificity 78.9%; area under the curve [AUC]=0.770). NLR (cut-off=8.45) showed 76.9% sensitivity and 68.0% specificity (AUC=0.755). NLPR (cut-off=0.027) had 76.9% sensitivity and 54.4% specificity, while SII (cut-off=2414) achieved 69.2% sensitivity and 72.1% specificity (all p<0.05). All indices were significant predictors of severe ACC.

CBC-derived systemic inflammatory indices, particularly MII and NLR, are effective, accessible, and inexpensive markers for predicting the severity of ACC. These parameters may complement clinical assessment and assist in decision-making, especially in situations where imaging is unavailable or inconclusive.