Neutrophil-to-lymphocyte ratio as a predictor of peritonitis in acute appendicitis | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 41, Issue 3, April 2023 PDF (1.14 MB) | ||||
| DOI: 10.4103/ejs.ejs_242_22 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Atmanand Verma; Ismail A. Shafik; Abd R. Mashour; Ahmad Y.A. Dayem | ||||
| Abstract | ||||
| Background Acute appendicitis (AA) is one of the most common causes of acute abdomen. Several imaging, laboratory and inflammatory markers, and scoring systems were developed to diagnose AA, but early and accurate diagnosis is still a matter of debate, despite great advances in diagnosis. Failure to diagnose AA at early stages can lead to severe complications. Neutrophil-to-lymphocyte ratio (NLR) is a potential marker to predict appendicitis and its severity. The neutrophil count highlights active and continuing inflammation, whereas the lymphocyte count highlights the regulatory pathway. This study was conducted to evaluate the validity and diagnostic accuracy of NLR to distinguish noncomplicated and complicated appendicitis with or without peritonitis. Patients and methods A total of 94 patients diagnosed as AA who underwent appendectomy were included in our study. NLR was generated from absolute count of total leukocyte count. Perioperative and histopathological findings were compared with NLR as an outcome predictor. Receiver operating characteristic curve analysis was performed to determine the cutoff value of NLR for AA and its severity. Results NLR mean correlated (<0.001) in noncomplicated and complicated AA with or without peritonitis. The receiver operating characteristic curve identified that patients with NLR greater than eight had sensitivity 100%, specificity 89.1%, and a 96% area under curve (AUC) in complicated AA with peritonitis. Similarly, NLR 5.3–8.0 had sensitivity 94.7% and specificity 58.7 and 63% AUC in complicated AA without peritonitis and NLR less than equal to 5.3 had sensitivity 88.9%, specificity 85.3% with AUC of 91% noncomplicated appendicitis. Conclusion NLR predicts both diagnosis and severity of AA. This may have implications for prioritizing cases for surgery, for monitoring conservatively treated patients, and for patients (pregnant and pediatric) who do not routinely undergo computed tomography scan. | ||||
| Keywords | ||||
| acute appendicitis; lymphocyte; Neutrophil; peritonitis | ||||
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