EP.FRI.477 Neutrophil-To-Lymphocyte Ratio (NLR) as a Predictor of Acute Appendicitis

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.

Predictors of Complicated Appendicitis with Evolution to Appendicular Peritonitis in Pediatric Patients

“…Acute appendicitis is the most frequently misdiagnosed cause of acute abdomen pain in children due to the delay or misdiagnosis being attributed to non-specific symptoms, overlapping of symptoms with other pathologies, and the difficult abdominal examination, especially in younger patients [ 8 ]. The lag in diagnosis carries with it a high risk of gangrene, perforation, intra-abdominal abscess formation, peritonitis, and sepsis, thus increasing morbidity rates [ 2 , 16 ].…”

“…Although complete clinical judgment, laboratory findings, and imaging modalities are usually necessary to make the diagnosis, all have limitations. In this regard, a search for some other diagnostic parameters was necessary [ 8 ].…”

“…The accuracy of white blood cells (WBC) and neutrophils for diagnosis of appendicitis differ among articles, as normal leukocyte counts do not exclude appendicitis, and CRP is a sensitive test, but non-specific for acute appendicitis [ 2 , 7 ]. However, CRP and procalcitonin, as well as novel derived biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were successfully used as severity markers in predicting complicated appendicitis in children [ 8 , 9 , 10 , 11 ]. These are easy, inexpensive markers of inflammation that are obtained easily.…”

“…These are easy, inexpensive markers of inflammation that are obtained easily. NLR is a new inflammatory biomarker and its value rests on its readily available nature, is calculated from CBC, is inexpensive, and is easily applicable [ 8 ].…”

The Role of Serum C - reactive protein, White Blood Cell Count and Neutrophils Percentage in the Diagnosis of Childhood Acute Appendicitis

“…Due to the lack of definitive preoperative blood tests, the rate of negative appendectomy is still very high. 9 The diagnosis of acute appendicitis is most common clinical matter in the pediatric age group 10 . Clinical accuracy in diagnosing acute appendicitis ranges between 75% and 95%, but this is dependent on the surgeon's clinical skills.…”