Assessment of systemic immune-inflammatory index and other inflammatory parameters in predicting mortality in patients with acute cholecystitis: A retrospective observational study

Abstract

Objective: To investigate the effectiveness of the systemic immune-inflammatory (SII) index and other inflammatory parameters in predicting mortality among patients with acute cholecystitis (AC). Methods: 279 Patients presented to the emergency department with abdominal pain and diagnosis of AC between September 2021 and September 2023 were included in the study. Demographic data, laboratory parameters, clinical follow-ups, and outcomes of the patients were recorded. Results: The mean age of the patients was (55.0±16.3) years and 36.6% were male. 63.8% Had gallbladder/choledochal stones and 49.5% underwent surgery. The mortality rate was 6.1%. Advanced age (P=0.170) and prolonged hospitalization (P=0.011) were statistically significant risk factors for mortality. Decreased lymphocyte count (P=0.020) and increased C-reactive protein (CRP) levels (P=0.033) were found to be risk factors for mortality. According to the mortality predictor ROC analysis results, the cut-off for SII index was 3 138 (AUC=0.817, sensitivity=70.5%, specificity=84.7%), the cut-off for neutrophil count was 15.28×10³/mm³ (AUC=0.761, sensitivity=52.9%, specificity=95.0%), the cut-off for leukocyte count was 19.0×10³/mm³ (AUC=0.714, sensitivity=52.9%, specificity=98.0%), cut-off for CRP was 74.55 (AUC=0.758, sensitivity=70.5%, specificity=79.0%), cut-off for aspartate transaminase (AST) was 33.0 IU/L (AUC=0.658, sensitivity=82.3%, specificity=50.3%). Conclusions: The SII index may be a good predictor of mortality with high sensitivity and specificity. Elevated levels of neutrophils, leukocytes, CRP, and AST are other inflammatory parameters that can be used to predict mortality associated with AC.

Keywords

Abdominal pain / Acute cholecystitis / Systemic immune-inflammatory index / Mortality / Inflammation / Emergency department

References

[1] Laméris W, van Randen A, Dijkgraaf MG, Bossuyt PM, Stoker J, Boermeester MA. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale. BMC Emerg Med 2007; 7: 9.

[2] Lam R, Zakko A, Petrov JC, Kumar P, Duffy AJ, Muniraj T. Gallbladder disorders: A comprehensive review. Mon DM 2021; 67(7): 101130.

[3] Cao Y, Li P, Zhang Y, Qiu M, Li J, Ma S, et al. Association of systemic immune inflammatory index with all—cause and cause—specific mortality in hypertensive individuals: Results from NHANES. Front Immunol 2023; 14: 1087345.

[4] Lee SO, Yim SK. Management of acute cholecystitis. Korean J Gastroenterol 2018; 71(5): 264-268 [in Korean].

[5] Karakaş DO, Yeşiltaş M. Validity of the Glasgow prognostic score and modified systemic inflammation score in predicting complicated cholecystitis. Hippokratia 2020; 24(1): 15-20.

[6] Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of systemic immune—inflammation index in cancer: A meta—analysis. J Cancer 2018; 9(18): 3295-3302.

[7] Zhong JH, Huang DH, Chen ZY. Prognostic role of systemic immune—inflammation index in solid tumors: A systematic review and meta—analysis. Oncotarget 2017; 8(43): 75381-75388.

[8] Celikbilek M, Dogan S, Ozbakır O, Zararsız G, Kücük H, Gürsoy S, et al. Neutrophil—lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal 2013; 27(1): 72-76.

[9] Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012; 5(1): 2.

[10] Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, et al. A comparison of inflammation—based prognostic scores in patients with cancer. A Glasgow inflammation outcome study. Eur J Cancer 2011; 47(17): 2633-2641.

[11] Şener K, Çakır A, Kılavuz H, Altuğ E, Güven R. Diagnostic value of systemic immune inflammation index in acute appendicitis. Rev Assoc Médica Bras 2023; 69(2): 291-296.

[12] Yildiz G, Selvi F, Bedel C, Zortuk O, Mutlucan UO. Systemic inflammation response index and systemic immune—inflammation index are associated with severity of acute pancreatitis. J Clin Med Kazakhstan 2023; 20(3): 44-48.

[13] Thapa P, Adhikari KM, Sharma A. Correlation between the severity and outcome of acute calculous cholecystits according to Tokyo guidelines. J Nepalgunj Med Coll 2019; 17(1): 34-37.

[14] Özdemir S, Altunok İ, Özkan A, İslam MM, Algın A, Eroğlu SE. The role of the hematological inflammatory index and systemic immuno—inflammation index in acute cholecystitis. Eur J Clin Exp Med 2022; 20(3): 330-335.

[15] Uludağ SS, Akıncı O, Güreş N, Tosun Y, Şanlı AN, Zengin AK, et al. An investigation into the predictive role of serum inflammatory parameters in the diagnosis of complicated acute cholecystitis. Ulus Travma Acil Cerrahi Derg 2022; 28(6): 818-823.

[16] Bedel C. Can we use neutrophil lymphocyte ratio and platelet lymphocyte ratio as a potential biomarker for acute cholecystitis? Ortadoğu Tıp Derg 2019; 11(4): 404-408.

[17] Serban D, Stoica PL, Dascalu AM, Bratu DG, Cristea BM, Alius C, et al. The significance of preoperative neutrophil—to—lymphocyte ratio (NLR), platelet—to—lymphocyte ratio (PLR), and systemic inflammatory index (SII) in predicting severity and adverse outcomes in acute calculous cholecystitis. J Clin Med 2023; 12(21): 6946.

[18] Jain A, Mehta N, Secko M, Schechter J, Papanagnou D, Pandya S, et al. History, physical examination, laboratory testing, and emergency department ultrasonography for the diagnosis of acute cholecystitis. Acad Emerg Med 2017; 24(3): 281-297.