Perbandingan Neutrophil-To-Lymphocytes Ratio dengan Platelet-To-Lymphocytes Ratio dan Neutrophil-and-Hemoglobin-To-Lymphocytes Ratio Pra-Operatif sebagai Prediktor Mortalitas Pasca-Laparotomi Emergensi pada Peritonitis Perforasi

Joseph Paskalis Osok, dr. Nurcahya Setyawan, Sp.B, Subsp.B.D.(K).; Dr. dr. Adeodatus Yuda Handaya Sp.B, Subsp.B.D.(K), FINACS

2026 | Tesis-Spesialis | S2 Ilmu Bedah

Latar Belakang: Peritonitis perforasi merupakan kegawatdaruratan bedah dengan mortalitas tinggi. Diperlukan biomarker hematologi pra-operatif yang cepat dan murah seperti Neutrophil-to-Lymphocytes Ratio (NLR), Platelet-to-Lymphocytes Ratio (PLR), dan Neutrophil-and-Hemoglobin-to-Lymphocytes Ratio (NHLR) untuk memprediksi risiko kematian pasien secara dini.

Tujuan: Membandingkan kemampuan prediktif NLR, PLR, dan NHLR pra- operatif terhadap mortalitas pasca-laparotomi emergensi pada pasien peritonitis perforasi di RSUP Dr. Sardjito.

Metode: Cross-sectional study retrospektif ini mengevaluasi data rekam medis pasien peritonitis perforasi periode 2019–2024. Data laboratorium pra-operatif dianalisis menggunakan uji bivariat Mann-Whitney dan uji multivariat regresi logistik biner untuk menilai hubungannya dengan mortalitas.

Hasil: Angka mortalitas pasca-laparotomi tercatat sebesar 23,5%. Analisis bivariat menunjukkan nilai median NLR (14,37 vs 9,40; p=0,002) dan NHLR (11,87 vs 7,41; p<0 p=0,207).>

Kesimpulan: NHLR dan NLR pra-operatif berhubungan signifikan dengan mortalitas pasca-laparotomi pasien peritonitis perforasi, dengan NHLR menunjukkan potensi prediktif yang paling unggul. Kedua parameter ini dapat digunakan sebagai alat stratifikasi risiko awal di unit gawat darurat.

Background: Perforated peritonitis is a surgical emergency associated with high mortality. Rapid and cost-effective preoperative hematological biomarkers—such as the Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Neutrophil-and-Hemoglobin-to-Lymphocyte Ratio (NHLR)—are needed to predict patient mortality risk early.

Objective: To compare the predictive ability of preoperative NLR, PLR, and NHLR regarding post-emergency laparotomy mortality in patients with perforated peritonitis at Dr. Sardjito General Hospital.

Methods: This retrospective cross-sectional study evaluated the medical records of perforated peritonitis patients from the 2019–2024 period. Preoperative laboratory data were analyzed using the bivariate Mann-Whitney test and multivariate binary logistic regression to assess their association with mortality.

Results: The post-laparotomy mortality rate was 23.5%. Bivariate analysis showed that the median values of NLR (14.37 vs. 9.40; p=0.002) and NHLR (11.87 vs. 7.41; p<0 p=0.207).>

Conclusion: Preoperative NHLR and NLR are significantly associated with post- laparotomy mortality in perforated peritonitis patients, with NHLR demonstrating the most superior predictive potential. Both parameters can be utilized as early risk stratification tools in the emergency department.

Kata Kunci : Peritonitis Perforasi, Laparotomi, Mortalitas, NLR, PLR, NHLR.