Predictive Value of the Neutrophil‒Lymphocyte Ratio in the Risk Stratification and Prognosis for Patients with Acute Cholangitis: A Single-Center Retrospective Study

Xin Deng,1 Tong Mou,1 Yu Zhu,2 Jing-Wen Wang2,31Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Neurology, Banan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Jing-Wen Wang, Department of Neurology, Banan Hospital of Chongqing Medical University, No. 659 Yunan Avenue, Longzhouwan Subdistrict, Banan District, Chongqing, 401320, People’s Republic of China, Email gdmnxh@sina.comBackground: Acute cholangitis (AC) is a serious bile duct infection that arises from bile obstruction and can lead to significant morbidity and mortality. The neutrophil‒lymphocyte ratio (NLR) is a widely used biomarker of inflammation. This study aims to assess the ability of NLR to predict disease severity and clinical outcomes.Methods: We performed a retrospective single-center observational analysis of 197 AC patients who received treatment in the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Chongqing Medical University between November 2021 and December 2023.Results: This study revealed that the five biomarkers (white blood cell (WBC) count, C-reactive protein (CRP), procalcitonin (PCT) levels and neutrophil percentage (N%)) increased significantly with increasing severity of AC. The analysis of biomarkers aimed at distinguishing patients with moderate to severe AC from those with mild AC, as well as severe AC from mild to moderate AC, revealed that the area under the curve (AUC) values for the NLR were 0.847 and 0.800, respectively. These AUC values were significantly higher than those of traditional inflammatory markers, including WBC count (0.657, 0.635), CRP (0.711, 0.720) and N% (0.710, 0.674). Furthermore, the NLR was strongly positively correlated with other inflammatory markers according to the results of Spearman’s test (p< 0.05). NLR was consistently a significant predictor of severe AC in both models (OR: 1.036, 1.039). AC patients with a high NLR (> 15.93) level at admission had a lower survival rate during hospitalization.Conclusion: NLR may serve as a convenient and simple biomarker for risk stratification and prognosis prediction in patients with AC.Keywords: acute cholangitis, neutrophil‒lymphocyte ratio, inflammation, biomarker, sepsis