Usefulness of the Pediatric Appendicitis Score and Neutrophil to Lymphocyte Ratio for Assessing the Complicated Appendicitis in Children

Abstract The most common reason for an acute surgical assessment of the abdomen is acute appendicitis with a rate as high as 30 %There is a lifetime risk of 8.6% and 6.7% in men and women respectively. The common age for presentation is between that of 5 and 4.4 while 28 is the median age. The objective of this study was to determine the diagnostic accuracy of (NLR) neutrophil-to-lymphocyte ratio to prognosticate severe/ complicated appendicitis by taking histopathology of the appendix as a gold standard. Methodology This cross-sectional validation study was conducted at the department of surgery and western vascular institute, University College Hospital Galway, Ireland retrospectively for a period of 6 months in 2016 And approximately 186 cases with appendicitis were enrolled in the study. Results The mean age of patients in this study was 29.15±9.54 years, the ratio of male to female was 1:1.7. The sensitivity, Specificity was 97.1% and 25.2% respectively and the diagnostic accuracy of NLR was 38.7% taking histopathology as the gold standard. We observed that the sensitivity, specificity, and diagnostic accuracy of NLR changes with the duration of symptoms in days, the sensitivity, specificity, and diagnostic accuracy of NLR was 100%, 17.0%, and 28.7% respectively for <3days and 92.3%, 93.75% and93.1% respectively for >3 days. Conclusion According to our study results the (NLR) neutrophil-to-lymphocyte ratio is a highly sensitive tool to predict severe/ complicated appendicitis by taking histopathology as the gold standard, but with the low value of diagnostic accuracy in terms of specificity.

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Can neutrophil-to-lymphocyte ratio be used as a predictor in acute appendicitis?

Journal of Emergency Medicine Trauma and Acute Care ◽

10.5339/jemtac.2021.6 ◽

2021 ◽

Vol 2021 (1) ◽

Author(s):

Chirag Pereira ◽

Manohar Martis ◽

Rohan D'Souza ◽

Leo F. Tauro

Keyword(s):

Operating Characteristic ◽

Receiver Operating Characteristic Analysis ◽

Abdominal Ultrasound ◽

Complicated Appendicitis ◽

Neutrophil To Lymphocyte Ratio ◽

Characteristic Analysis ◽

Lymphocyte Ratio ◽

Medical College ◽

Uncomplicated Appendicitis ◽

Ethical Approval

Background: To determine if neutrophil-to-lymphocyte ratio (NLR) can be used to diagnose appendicitis and distinguish complicated from uncomplicated appendicitis. The secondary aim was to determine if the appendix cut-off size on ultrasound matches that of existing literature. Methods: We retrospectively analyzed all cases that underwent appendectomy in Father Muller medical college and hospital from 2014 to 2019. The NLR, histopathology, and ultrasound reports for all patients were reviewed. Recommended cut-off values for NLR and appendicular size on ultrasound were determined using receiver operating characteristic analysis (ROC). Data was analyzed using SPSS version 25. Ethical approval was obtained for this study. Results: We included 1623 patients in this study. The patients’ median age was 24 years, with appendicitis being more common in males than females. NLR>2.4 was statistically associated with appendicitis with sensitivity of 70.1% and specificity of 43.2%. NLR>4.3 was statistically associated with complicated appendicitis with sensitivity of 72.25% and specificity of 54.09%. An appendicular diameter >6.1 mm was suggestive of appendicitis on abdominal ultrasound based on our analysis. Conclusions: NLR is a simple adjunct that can be used to diagnose appendicitis and identify complicated appendicitis.

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1575 Predictive Ability of Neutrophil-To-Lymphocyte Ratio in Acute Appendicitis

British Journal of Surgery ◽

10.1093/bjs/znab259.535 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

G Nawaz ◽

M Qayum ◽

S Hajibandeh ◽

S Hajibandeh

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

Predictive Ability ◽

Clinical History ◽

Complicated Appendicitis ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

History Of ◽

And Gender ◽

Sensitivity Specificity

Abstract Aim Neutrophil-to-lymphocyte ratio (NLR) predicts both diagnosis and severity of appendicitis. We aimed to evaluate accuracy of NLR to predict acute appendicitis and whether it can distinguish between uncomplicated and complicated appendicitis. Method Patients of any age and gender presenting with clinical history of acute appendicitis over a 4 month period were included. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of NLR were evaluated considering the cut-off values of 4.7 for acute appendicitis and 8.8 for complicated appendicitis. Results A total of 54 patients were included. Thirty-eight patients had acute appendicitis of whom 21 (55.2%) had complicated appendicitis. NLR was associated with sensitivity of 89.4%, specificity of 81.2%, PPV 91.8%, NPV of 76.5%, and accuracy of 87.0% for acute appendicitis. Moreover, it was associated with sensitivity of 61.4%, specificity of 78.9%, PPV 76.5%, NPV of 65.2%, and accuracy of 70.0% for complicated appendicitis. Conclusions NLR has acceptable sensitivity, specificity, PPV, NPV and accuracy to predict uncomplicated and complicated appendicitis with relatively better ability to predict the former. NLR can be utilised for prioritising cases for surgery, for monitoring conservatively treated patients and for patients who do not routinely undergo CT scan (pregnant or paediatric patients).

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Neutrophil to lymphocyte ratio in diagnosis of complicated and non-complicated appendicitis

Sri Lanka Journal of Child Health ◽

10.4038/sljch.v46i1.8238 ◽

2017 ◽

Vol 46 (1) ◽

pp. 59

Author(s):

Mervan Bekdas ◽

Hulya Ozturk ◽

Sevil Bilir Goksugur ◽

Fatih Demircioglu ◽

Metin Tahaoglu

Keyword(s):

Complicated Appendicitis ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

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Clinical Impact of Myeloid-Derived Suppressor Cells, Lymphocyte Subsets, and Neutrophil-to-Lymphocyte Ratio in Patients with Colorectal Cancer

Laboratory Medicine Online ◽

10.3343/lmo.2020.10.1.75 ◽

2020 ◽

Vol 10 (1) ◽

pp. 75

Author(s):

Min-Gu Kang ◽

Chang Hyun Kim ◽

Soo Hyun Kim ◽

Jong-Hee Shin ◽

Hye Ran Kim ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymphocyte Subsets ◽

Suppressor Cells ◽

Clinical Impact ◽

Neutrophil To Lymphocyte Ratio ◽

Myeloid Derived Suppressor Cells ◽

Lymphocyte Ratio

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Inflammation and Congenital Heart Disease Associated Pulmonary Hypertension

The Heart Surgery Forum ◽

10.1532/hsf.1228 ◽

2015 ◽

Vol 18 (1) ◽

pp. 038 ◽

Cited By ~ 2

Author(s):

Mete Gursoy ◽

Ece Salihoglu ◽

Ali Can Hatemi ◽

A. Faruk Hokenek ◽

Suleyman Ozkan ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Neutrophil To Lymphocyte Ratio ◽

Cell Distribution ◽

Inflammation Markers ◽

Distribution Width ◽

Artery Pressure ◽

Lymphocyte Ratio ◽

Mean Pulmonary Artery Pressure ◽

Pulmonary Arterial

Background: Increased blood flow may trigger pulmonary arterial wall inflammation, which may influence progression of pulmonary artery hypertension in patients with congenital heart disease. In this study, we aimed to investigate the correlation between preoperative inflammation markers and pulmonary arterial hypertension. Methods: A total of 201 patients with pulmonary hypertension were enrolled in this study retrospectively; they had undergone open heart surgery between January 2012 and December 2013. Patients’ preoperative C-reactive protein (CRP), neutrophil to lymphocyte ratio, red blood cell distribution width, pulmonary pressures, and postoperative outcomes were evaluated. Results: Patient age, neutrophil to lymphocyte ratio, red blood cell distribution width, and CRP were found to be significantly correlated with both preoperative peak and mean pulmonary artery pressures. These data were entered into a linear logistic regression analysis. Patient age, neutrophil to lymphocyte ratio, and CRP were found to be independently correlated with peak pulmonary pressure (P < .001, P < .001, and P = .004) and mean pulmonary artery pressure (P < .001, P < .001, and P = .001), whereas preoperative mean pulmonary artery pressure was found to be independently correlated with intensive care unit stay (P < .001). No parameter was found to be significantly correlated with extubation time and mortality. Eighteen patients had experienced pulmonary hypertensive crisis; in this subgroup, patients’ mean pulmonary artery pressure and neutrophil to lymphocyte ratio were found to be significant (P = .047, P = .003). Conclusion: Preoperative inflammation markers may be correlated with the progression of pulmonary hypertensive disease, but further studies with larger sample size are needed to determine the predictive role of these markers for postoperative outcomes.

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