The neutrophil-to-lymphocyte ratio has feasible predictive value for hospital mortality in patients with small bowel obstruction in the emergency department

Abstract

Purpose: The neutrophil-to-lymphocyte ratio (NLR) is an effective predictor of mortality in patients with various conditions. To the best of our knowledge, there have been no previous studies on the NLR as a prognostic marker for small bowel obstruction (SBO), especially on admission to the emergency department (ED). Methods: From January 2009 to December 2018, 653 patients diagnosed with SBO in the ED were included. Clinical and laboratory results, including the NLR, were evaluated as variables. The NLR was calculated as follows: NLR = absolute neutrophil count/absolute lymphocyte count. To evaluate SBO prognosis, data on hospital mortality and intensive care unit (ICU) admission were obtained. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed. Results: Among the 653 patients, 16 (2.4%) died and 35 (5.3%) were admitted to the ICU during hospitalization. Multivariate logistic regression analysis demonstrated the NLR as an independent factor for predicting death (odds ratio, 1.3; p = 0.017]); however, there was no statistical significance for ICU admission (p = 0.94). The NLR showed good predictive performance for in-hospital mortality (area under the ROC curve, 0.768 [95% confidence interval, 0.620–0.861]; cut-off value, 10.6; p = 0.018). Conclusion: The NLR was positively associated with poor SBO prognosis. An elevated NLR was an independent predictive factor for in-hospital mortality in SBO patients. Emergency physicians should consider the NLR for SBO prognosis, and timely, aggressive, and prompt treatment is required, especially in patients with an NLR >10.6. © 2020 Elsevier Inc.