Clinical Value of the Platelet-to-Lymphocyte Ratio for Diagnosing Complicated Acute Appendicitis

Abstract

Amaç: Akut apandisit (AA) dünyada en yaygın gözüken acil cerrahi hastalıktır. Preoperatif olarak bakılan ileri radyolojik görüntüleme yöntemlerine rağmen, komplike olguların değerlendirilmesi hala önemli bir sorun teşkil etmektedir. Bu çalışmada, platelet-lenfosit oranının ve beyaz küre değerinin komplike ve komplike olmayan apandisit olgularının ayrımında klinik etkinliğini ortaya koymaya amaçladık. Yöntem: Acil servise akut karın bulgularıyla başvurup AA ön tanısıyla acil laparotomi yapılan hastalar çalışmaya dahil edildi. Platelet-lenfosit oranı ve beyaz küre değerleri ölçüldü. Hastalar komplike olmayan olgular grup 1, komplike olgular ise grup 2 olarak karşılaştırıldı. Her iki grup arasında beyaz küre ve platelet-lenfosit oranları istatistiksel olarak karşılaştırıldı. Bulgular: Yüz doksan altı hasta grup 1, 43 hasta grup 2'de idi. Cinsiyet dağılımı gruplar arasında homojendi (p=0,020); grup 2 ortalama yaşı grup 1'e göre daha yüksekti (p<0,001). Platelet-lenfosit oranı grup 2'de anlamlı ölçüde yüksekti. Beyaz küre sayımı da grup 2'de anlamlı oranda yüksekti (sırasıyla p<0,001 ve p=0,029). Platelet-lenfosit oranı aynı zamanda yaş ve cinsiyetten bağımsız olarak komplike olguları öngörebilmekteydi (p<0,001). Platelet-lenfosit oranının cut-off değeri 169,7 iken, %74,4 sensitivitesi ve %73,5 spesifitesi mevcuttu. Sonuç: Platelet-lenfosit oranı komplike apandisit olgularını beyaz küre sayımına oranla daha yüksek bir sensitivite ve spesifite ile öngörebilmektedir. Anahtar Kelimeler: Akut apandisit, perfore apandisit, platelet, lenfosit, beyaz küre ÖZ ABSTRACTAim: Acute appendicitis (AA) is the most common acute surgical disease worldwide. Despite the use of preoperative advanced radiological instruments, preoperative determination of complicated cases is still difficult and remains an important concern. The aim of this study is to evaluate the predictive value of the platelet-to-lymphocyte ratio and of the presence of elevated white blood cells to discriminate between complicated and uncomplicated AA. Method: All patients who were admitted to the emergency care unit and underwent urgent laparotomy for AA were analyzed retrospectively. The platelet-to-lymphocyte ratio and white blood cell count were measured. Patients were divided into two groups: uncomplicated cases (group 1) and complicated cases (group 2). White blood cell count and platelet-to-lymphocyte ratio were compared between the two groups. Results: There were 196 patients in group 1 and 43 patients in group 2. The gender distribution between groups was homogeneous (p=0.020); the mean age of group 2 was higher than group 1 (p<0.001). The platelet-to-lymphocyte ratio was significantly higher in group 2; there was also a significant difference in the white blood cell count (p<0.001 and p=0.029 respectively). The platelet-to-lymphocyte ratio was significantly higher in group 2, and was predictive of complications independently of age and gender (p<0.001). The cutoff value of the platelet-to-lymphocyte ratio was 169.7, giving a sensitivity of 74.4% and specifi...

Associations of novel inflammatory markers with long‐term outcomes and recurrence of diverticulitis

“…High NLR and PLR values were shown to be associated with complicated abdominal infections and worse outcomes. [9][10][11][12] Debate is currently ongoing about the utility of NLR and PLR as inflammatory markers in diverticulitis. Of particular interest are associations with disease severity and clinical outcomes, and with the need for urgent interventions including surgery or CT-guided drainage of abscess.…”

“…Several studies have demonstrated the effectiveness of NLR and PLR as prognostic markers in various malignant 4–6 and benign 7,8 conditions. High NLR and PLR values were shown to be associated with complicated abdominal infections and worse outcomes 9–12 . Debate is currently ongoing about the utility of NLR and PLR as inflammatory markers in diverticulitis.…”

Can Neutrophil-Lymphocyte Ratio in Complete Blood Count Help in the Differential Diagnosis Between Acute Appendicitis and Right Ureteral Stones in Pediatric Age Groups?

“…The secretion of cytokines is increased at the beginning of inflammation in platelets like neutrophils, and increased cytokines contribute to the increase of inflammation by increasing the synthesis of new neutrophils and platelets. PLR has been used to evaluate the inflammatory process leading to the release of pro-inflammatory cytokines and the proliferation of megakaryocytes [19]. In a study published by Bekdas et al [20], the sensitivity was 61.8% and specificity was 62.5% for PLR in the differentiation of simple versus complex appendicitis in children.…”

Leukocytes are not Reliable in Predicting Possible Diaphragmatic Injury in Patients with Penetrating Left Thoracoabdominal Stab Wounds

“…The response to conditions such as trauma, infection, and inflammation is an increase in neutrophils and thrombocytes and a decrease in lymphocytes. The NLR and PLR have recently been used as indicators of inflammation in many areas [24][25][26][27][28][29][30]. Thus, this study was planned by considering that the leukocytes, leukocyte subsets, platelets, NLR, and PLR may guide the detection of diaphragmatic injuries.…”