A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka

Ahmad, Khairol Ashraf; Ideris, Noorharisman; Aziz, Syed Hassan Syed Abd

doi:10.21315/mjms2019.26.6.6

Cited by 18 publications

(25 citation statements)

References 25 publications

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“…In cases of mortality, the mean value of NLR exceeded that of patients with generalized peritonitis. These aspects have been observed previously by researchers who have noted that NLR has a better sensitivity and specificity than other serological markers in predicting the incidence of complications in patients with acute appendicitis (22)(23)(24).…”

Section: Discussionsupporting

confidence: 74%

The role of neutrophil-to-lymphocyte ratio as an outcome predictor factor in acute appendicitis: a single medical center’s experience

Grigorescu

Suciu

Săplăcan³

et al. 2022

Revista Romana De Medicina De Laborator

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Introduction: Acute abdominal pain persists in defying modern diagnostic procedures. Inflammatory response variables in urine and blood tests can help rule out other disorders and support a clinical diagnosis of acute appendicitis (AA), but there is no specific blood test that can diagnose AA. In order to address this, our study sought to establish the value of (NLR) as a prognostic and severity predictor in patients with AA. Material and method: We conducted an observational retrospective study of 356 patients who had undergone surgery for AA, assessing NLR as an outcome metric. The NLR was estimated using the differential WBC (white blood count) reported on admission; the data obtained were then recorded in a database and statistically analyzed. Results: The NLR medians correlated (p<0.001) in uncomplicated AA, AA with localized peritonitis, and AA with generalized peritonitis (Kruskal-Wallis test). The ROC curve identified 81.4 % sensitivity, 62.5 % specificity, and a 73 % AUC in localized peritonitis. The NLR value was associated with generalized peritonitis with a sensitivity of 63.7 %, specificity of 64.3 %, and AUC of 68.2%. The NLR-patient death association had 100% sensitivity, 80.3% specificity, and 93.5 AUC. Conclusion: NLR determination in individuals with acute appendicitis may be useful in predicting complications. NLR values greater than 7.86 are usually related with generalized peritonitis, while values larger than 12.9 may predict an increased risk of patient death. Calculating NLR from a complete blood count is a straightforward and cost-effective method of analyzing complicated AA in resource-constrained settings.

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Section: Discussionsupporting

confidence: 74%

The role of neutrophil-to-lymphocyte ratio as an outcome predictor factor in acute appendicitis: a single medical center’s experience

Grigorescu

Suciu

Săplăcan³

et al. 2022

Revista Romana De Medicina De Laborator

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“…Similar to the literature, we found a strong association between preoperative CRP, neutrophil, NLR values, and high conversion rate. Among studies reporting on the operative difficulty, Ahmad et al identified high NLR values due to high neutrophils count and low lymphocytes count as a strong predictor for conversion [ 29 ]. A study by Shelton et al also noted that a preoperative CRP level of >150mg/dL is a statistically significant predictor of conversion, corroborates our outcomes [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Preoperative Imaging Features and Blood Tests in Predicting the Increased Risk of Conversion in Laparoscopic Appendectomy Surgery

Yiğit¹,

Cerekci²,

Cakir³

et al. 2021

Cureus

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Background In this study, we identified preoperative risk factors, including imaging features and blood tests, to predict conversion from laparoscopic appendectomy to open appendectomy. Thus, we aimed to prevent patients from being exposed to the risks of laparoscopy by choosing patients for whom proceeding directly to an open surgery as an initial approach was appropriate. Patients and methods The cohort of 632 patients who underwent laparoscopic appendectomy due to acute appendicitis in our center between January 2017 and March 2021 were analyzed, and 521 of these patients comprised the study population. Baseline characteristics, medical history, preoperative laboratory tests, imaging features, and postoperative pathologic findings of all patients according to groups who underwent laparoscopic appendectomy or conversion to open appendectomy were examined. Results Among 521 patients, the appendectomy procedure was completed laparoscopically in 498 (95.6%) patients, and conversion to open appendectomy was occurred in 23 (4.4%) patients. 223 (42.8%) patients were female, and 298 (57.2%) patients were male. The mean age of all patients was 35.17±12.61 years (range, 16-80 years). Preoperative ultrasonography feature associated with a higher rate of conversion was free fluid collection (p=0.001). The levels of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio on admission were found to be significantly higher in the conversion group compared to the laparoscopy group (p=0.001, p=0.027, p=0.02, respectively). Conclusions Free fluid collection detected by ultrasonography, and elevation of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio may be useful in the prediction of a high risk of conversion appendectomy. Despite the unquestionable advantages of laparoscopic surgery, there are still substantial conversion rates. Within this framework, our study will help the surgeons to choose the most appropriate surgical methods for patients by evaluating them individually, and to inform them of the possibility of conversion to the open approach, and other risks before surgery.

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“…NLR has also been used as an indicator for the diagnosis and severity evaluation of acute appendicitis. Previous studies reported that the NLR could be used as an important parameter in the diagnosis of appendicitis[ 14 , 15 ], while there was also a substantial correlation between the NLR and disease severity. This study demonstrated that patients who selected nonsurgical management during the pandemic presented with higher N% and NLR.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: A single-center study

Zhang¹,

Zhang²,

Zhao³

2022

WJCC

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BACKGROUND Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, outcomes and management of many diseases have been affected. Acute appendicitis is a common acute abdomen. The incidence rate is 0.05%-0.5%. Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic. People avoided going to the hospital for fear of being infected. Different countries have different epidemic prevention measures that result in different treatment outcomes. The Chinese government also published some temporary measures in order to prevent the outbreak. AIM To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing. METHODS Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed. Cases were grouped according to admission year. The demographic characteristics, present illnesses, medical history, symptoms and signs, comorbidities, blood test results, imaging data, appendix pathology, and treatment details were compared. RESULTS Overall, 74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019, whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020. Fever, thick appendix, nonsurgical management, and uncomplicated appendicitis (simple or supportive appendicitis) were more common in group 2020 ( P < 0.05). Among the nonsurgical management cases, the neutrophil percentage, neutrophil-to-lymphocyte ratio, and recurrence rate were higher in group 2020 ( P < 0.05). Among surgically managed cases, there were more cases with gastrointestinal symptoms, peritonitis, ascites in the image, and intraoperative adhesion or ascites in group 2020 ( P < 0.05). The white blood cell count, time from diagnosis to surgery, surgical time, and intraoperative blood loss were higher in group 2020 ( P < 0.05). CONCLUSION During the COVID-19 pandemic, patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment. For patients who underwent surgical management, the operation was delayed and more difficult during the pandemic. Nevertheless, the hospital stay and the incidence of postsurgical complications did not change.

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A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka

Cited by 18 publications

References 25 publications

The role of neutrophil-to-lymphocyte ratio as an outcome predictor factor in acute appendicitis: a single medical center’s experience

The role of neutrophil-to-lymphocyte ratio as an outcome predictor factor in acute appendicitis: a single medical center’s experience

Efficacy of Preoperative Imaging Features and Blood Tests in Predicting the Increased Risk of Conversion in Laparoscopic Appendectomy Surgery

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: A single-center study

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