Associations of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, and lymphocyte–monocyte ratio with postoperative outcomes in sigmoid volvulus

Background: Sigmoid volvulus represents one of the three leading etiologies of acute colonic obstruction. The present study aimed to evaluate whether neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio values serve as reliable prognostic indicators in the postoperative period. Materials and Methods: Patients who underwent emergency surgery for sigmoid volvulus between 2023 and 2025 were analyzed retrospectively. Results: A total of 20 patients were identified. Postoperative morbidity rate was 30% and mortality rate was 15%. High preoperative platelet-to-lymphocyte ratio levels were significantly associated with postoperative mortality, and high preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and low preoperative lymphocyte-to-monocyte ratio levels were significantly associated with postoperative morbidity. Additionally, high neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio values measured on postoperative days 1 and 3 were found to correlate with both mortality and morbidity. To predict postoperative morbidity, the cutoff value for neutrophil-to-lymphocyte ratio was identified as 10.9 (sensitivity, 100%; specificity, 71.4%; area under the curve [95% confidence interval]: 0.810 [0.619–1.000]; P = 0.032). Although this threshold was statistically significant for morbidity in subgroup analyses, no significant association with mortality was observed. The platelet-to-lymphocyte ratio cutoff value was determined as 298.7 (sensitivity, 100%; specificity, 85.7%; area under the curve [95% confidence interval]: 0.952 [0.864–1.000]; P = 0.002). Subgroup analyses confirmed that the platelet-to-lymphocyte ratio cutoff retained statistical significance for both morbidity and mortality. Conclusions: This study suggests that inflammatory markers such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio may provide valuable prognostic insight regarding morbidity and mortality following surgery for sigmoid volvulus. The cutoff values established for these biomarkers may aid in the early identification of high-risk patients in both the preoperative and postoperative settings and contribute meaningfully to clinical decision-making.