Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis

Hajibandeh, Shahab; Hajibandeh, Shahin; Hobbs, Nicholas; Mansour, Moustafa

doi:10.1016/j.amjsurg.2019.04.018

Cited by 159 publications

(159 citation statements)

References 30 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…These physiological stressors also lead to raised neutrophil counts and decreased lymphocyte counts, resulting in elevated NLRs [23]. NLR has previously been shown to have high sensitivity and specificity within 6 h of inciting events, while WBC counts and band counts are less responsive [24,25]. As demonstrated in this study, WBC × NLR combines the utility of these two parameters into a single index that is more sensitive than either component alone.…”

Section: Factors Associated With a Secondary Bacterial Infection Frommentioning

confidence: 80%

Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study

Lin

Chen

Goh

et al. 2020

Toxins

View full text Add to dashboard Cite

Snakebites from Taiwan habus (Protobothrops mucrosquamatus) and green bamboo vipers (Viridovipera stejnegeri) account for two-thirds of all venomous snakebites in Taiwan. While there has been ongoing optimization of antivenin therapy, the proper management of superimposed bacterial wound infections is not well studied. In this Bacteriology of Infections in Taiwanese snake Envenomation (BITE) study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with snakebites from these two snakes. We further developed a BITE score to evaluate the probability of wound infections and guide antibiotic usage in this patient population. All snakebite victims who presented to the emergency departments of seven training and research hospitals and received at least one vial of freeze-dried hemorrhagic antivenin between January 2001 and January 2017 were identified. Patient biodata, laboratory investigation results, and treatment modalities were retrieved. We developed our BITE score via univariate and multiple logistic regression analyses. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the BITE score. Out of 8,295,497 emergency department visits, 726 patients presented with snakebites from a Taiwan habu or a green bamboo viper. The wound infection rate was 22.45%, with seven positive wound cultures, including six polymicrobial infections. Morganella morganii, Enterococcus spp., Bacteroides fragilis, and Aeromonas hydrophila were most frequently cultured. There were no positive blood cultures. A total of 33.0% (n = 106) of snakebite patients who received prophylactic antibiotics nevertheless developed wound infections, while 44.8% (n = 73) of wound infection patients were satisfactorily treated with one of the following antibiotics: amoxicillin/clavulanic acid, oxacillin, cefazolin, and ampicillin/sulbactam. With the addition of gentamicin, the success of antibiotic therapy increased by up to 66.54%. The prognostic factors for the secondary bacterial infection of snakebites were white blood cell counts, the neutrophil lymphocyte ratio, and the need for hospital admission. The area under the ROC curve for the BITE score was 0.839. At the optimal cut-off point of 5, the BITE score had a 79.58% accuracy, 82.31% sensitivity, and 79.71% specificity when predicting infection in snakebite patients. Our BITE score may help with antibiotic stewardship by guiding appropriate antibiotic use in patients presenting with snakebites. It may also be employed in further studies into antibiotic prophylaxis in snakebite patients for the prevention of superimposed bacterial wound infections.

show abstract

Section: Factors Associated With a Secondary Bacterial Infection Frommentioning

confidence: 80%

Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study

Lin

Chen

Goh

et al. 2020

Toxins

View full text Add to dashboard Cite

show abstract

“…Neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR) seem most valuable parameters. 1 NLR has already proved itself useful in prognostics of infectious diseases, 2 inflammatory conditions, 3 surgical emergencies, 4 postoperative complications 5 and as a bone loss index in postmenopausal women. 1,6 It can also be used for mortality stratification in major cardiac events.…”

Section: Introductionmentioning

confidence: 99%

<p>The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies – A Narrative Review</p>

Stefaniuk¹,

Szymczyk²,

Podhorecka³

2020

CMAR

View full text Add to dashboard Cite

Despite the presence of many hematological prognostic indexes, clinical course and overall survival are often highly variable even within the same patient subgroup. Recent studies suggest that simple, cost-effective, low-risk tests such as neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR) may be used to evaluate the prognosis. Their role has been well confirmed in diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL) and multiple myeloma (MM), but until now the prognostic significance of NLR and LMR in leukemias has not been widely reported. In this article, we analyze the literature data on prognostic value of NLR and LMR in haematological malignancies in the context of classic prognostic factors and clinical course.

show abstract

“…Clinical features, especially when two or more are combined, have been suggested as being valuable in the diagnosis of complicated appendicitis. The NLR is a simple clinical in ammatory marker, and the NLR provides information about two different immune and in ammatory pathways, which may make it a good marker for predicting appendicitis and its severity [15][16][17]. In our study, the optimal cutoff value for the NLR was 7, and an NLR greater than 7 indicated the presence of complicated appendicitis.…”

Section: Discussionmentioning

confidence: 58%

Nomogram for predicting complicated appendicitis and aiding decision-making regarding antibiotic therapy for acute appendicitis

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Antibiotic therapy is a feasible treatment option for uncomplicated appendicitis, but the preoperative diagnosis of uncomplicated appendicitis is challenging. This study aimed to develop a nomogram to predict complicated appendicitis based on laboratory data and CT features and to guide antibiotic treatment decision-making. Methods Patients with pathologically confirmed acute appendicitis (AA) were randomly split into the primary and validation cohorts. The nomogram model for predicting complicated appendicitis was constructed based on the results of the multivariate logistic analysis in the primary cohort and transformed into a nomogram risk score. The nomogram was validated in a validation cohort and an independent antibiotic therapy cohort. Results A total of 375 patients were included in the primary cohort, 168 patients were included in the validation cohort, and 169 patients were included in the antibiotic treatment cohort. In the primary cohort, multivariate analysis confirmed that periappendiceal fat stranding (PFS, p < 0.001, OR = 67.80), the C-reactive protein level (CRP ≥ 38, p < 0.001, OR = 5.77) and the neutrophil-to-lymphocyte ratio (NLR ≥ 7, p < 0.001, OR = 3.51) were independent risk factors for complicated appendicitis. The PFS, CRP and NLR scores were 10.0, 4.0 and 3.0 points, respectively, based on the nomogram. Each patient was assigned a score obtained with the nomogram, called the nomogram risk score, and the best cutoff value for the nomogram risk score was 11.0 points. Fourteen patients (3.7%, 14/375) and seven patients (4.2%, 7/168) with complicated appendicitis were classified as having uncomplicated appendicitis in the primary and validation cohorts, respectively. When the nomogram risk score was greater than 11, the failure rate of antibiotic treatment was 49.2%; when the nomogram risk score was less than 11, the failure rate of antibiotic treatment was only 5.3%. Furthermore, the predictive accuracy of the nomogram risk score for antibiotic treatment failure as measured by the area under the curve (AUC) was 0.823 (95% CI: 0.757–0.878). Conclusion We found that the proposed nomogram risk score based on clinical and CT features not only enables the accurate identification of complicated appendicitis patients before surgery but also serves to guide management decisions.

show abstract

Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis

Cited by 159 publications

References 30 publications

Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study

Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study

<p>The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies – A Narrative Review</p>

Nomogram for predicting complicated appendicitis and aiding decision-making regarding antibiotic therapy for acute appendicitis

Contact Info

Product

Resources

About