Neutropthil-to-Lymphocyte Ratio as a Predictor of Postsurgical Intraabdominal Abscess in Children Operated for Acute Appendicitis

Abstract

Aim of the study: Postoperative intra-abdominal abscess (PIAA) is a frequent and severe complication of acute appendicitis (AA) with peritonitis. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that has been related to the development of peritonitis; however, its diagnostic role in predicting PIAA has not been evaluated. This is the first study that analyzes the usefulness of NLR as a predictor of PIAA in children operated for AA.Material and Methods: Retrospective observational study in children operated for AA in our institution during 2017–2018. Patients aged under 5 years or with incomplete laboratory determinations at hospital admission (blood count, C-reactive protein, and fibrinogen) were excluded. Demographic and laboratory parameters and the development of PIAA were analyzed. NLR was calculated by dividing the absolute number of neutrophils by the absolute number of lymphocytes. By means of ROC curves, we determined the sensitivity and specificity of the different laboratory parameters to predict the development of PIAA.Results: A total of 388 patients aged 10.5 ± 2.9 year were included. Twenty (5.2%) developed PIAA. NLR presented an area under the curve (AUC) of 0.85, significantly higher than the determination of leukocytes (AUC 0.69, p < 0.001), neutrophils (AUC 0.74, p < 0.001), fibrinogen (AUC 0.68, p < 0.001) and C-reactive protein (AUC 0.73, p < 0.001). We estimated the optimal cut-off point of NLR > 10.5, with a sensitivity of 85% and a specificity of 75.2%.Conclusions: NLR is the laboratory parameter with the highest sensitivity and specificity for predicting the development of PIAA in children operated for AA. It can be useful as a predictor of worse postoperative course.

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

“…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).…”

Complicated Acute Appendicitis during COVID-19 Pandemic: The Hidden Epidemic in Children

“…Furthermore, the rate of complicated appendicitis has tripled when compared with previous years in this same period of time, reaching 48.4% since home confinement had begun, while this rate is usually around 10 to 15% of all patients diagnosed with AA in our area. 21 As a result, the average hospital stay of these patients has increased significantly, with an increase in direct and indirect costs, arising from the need for care by parents throughout the period of hospitalization.…”

Nuevo sistema de calificación diagnóstica para apendicitis pediátrica basado en parámetros hematológicos ajustados por edad y sexo

“…14 Recientemente, se han agregado parámetros rápidos, económicos y de fácil acceso como INL, IPL y ILM. [15][16][17][18][19] Zouari et al estudiaron a 102 niños consecutivos que se sometieron a apendicectomía y compararon el grupo con apendicitis aguda con el grupo de exploración negativa. 20 Informaron que un nivel de proteína C reactiva ≥ 10 mg/L al ingreso y una leucocitosis ≥ 16 100/mL eran factores predictivos de apendicitis aguda pediátrica.…”