Predicting the Severity of Acute Appendicitis in Children Using Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR)

Abstract

The ability to predict risk of perforation in acute appendicitis (AA) could direct timely management and reduce morbidity. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are surrogate severity markers in infections. This study investigates the use of PLR and NLR as a marker for distinguishing uncomplicated (UA) and complicated appendicitis (CA) in children. Materials and methodsThis retrospective single-center study collected data between January 1, 2014, and December 31, 2020. Children between five and 17 years of age with histologically confirmed appendicitis were included. Cut-off values for NLR and PLR were determined by employing the receiver operating characteristic (ROC) curve with sensitivity and specificity in addition to regression analysis. ResultsA total of 701 patients were included with a median age of 13 years. Out of which 52% of the cohort was female. The difference between the NLR and PLR ratios between UA and CA was significant (p=0.05, Kruskal-Wallis). For UA, the area under the ROC curve (AUC) and cut-off for NLR and PLR were 0.741, 3.80 with 95% CI of 0.701-0.781 and 0.660, 149.25 with 95% CI of 0.618-0.703, respectively. In CA, using NLR and PLR, AUC and cut-off were 0.776, 8.86 with 95%CI of 0.730-0.822 and 0.694, 193.67 with 95%CI of 0.634-0.755, respectively. All were significant with p<0.001. ConclusionsNLR and PLR are reliable, synergistic markers predicting complicated appendicitis which can guide nonoperative management in children.

Accuracy of Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Acute Appendicitis: A Single-Center Retrospective Study

“…In complicated appendicitis, using neutrophil-to-lymphocyte ratio and PLR, the AUC and cut-off were 0.776 and 8.86, respectively. Meanwhile, in the current study, the results agree with those found in the previous study (shown in Table 3), in which a significant association was seen between NLR and the occurrence of complications (p-value = 0.00001) [14].…”

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

“…A retrospective single-center study assessed the use of NLR and PLR in predicting the severity of acute appendicitis in children, and their statistical analysis demonstrated both factors as independent predictors of complicated appendicitis. Using NLR and PLR AUC and cut-off was 0.776, 8.86 with a 95% CI of 0.730–0.822 and 0.694, 193.67 with a 95% CI of 0.634–0.755, respectively [ 6 ].…”

“…Numerous scoring systems have been proposed in order to support the clinician in diagnosing and categorizing acute appendicitis, such as the Alvarado score, pediatric appendicitis score (PAS), the appendicitis inflammatory response (AIR), and Shera score. These scoring systems lack the sensitivity and specificity to anticipate the severity of acute appendicitis; thus, their use is not recommended by the WSES [ 6 ].…”

“…The accessible literature indicates that an NLR of 4.7 is a cut-off value for uncomplicated appendicitis and 8.8 for complicated appendicitis, with a sensitivity ranging from 62–92% and a specificity of 56–89% [ 6 ].…”

Un comentario acerca de los marcadores de severidad de la apendicitis aguda

“…Ayeni y colaboradores (6) respaldan el uso de la proporción de neutrófilos a linfocitos (NLR) y la proporción de plaquetas a linfocitos (PLR) para estratificar el riesgo de niños con apendicitis confirmada en entornos de recursos económicos limitados o donde no se encuentren los exámenes diagnósticos necesarios. Para el NLR, hallaron una sensibilidad del 70,3% y una especificidad del 70% con valor predictivo positivo (VPP) del 84,6% y un valor predictivo negativo (VPN) del 50,2%, y para el PLR, una sensibilidad del 64% y una especificidad del 61% con un VPP del 79,3% y un VPN del 42%.…”