The Role of Neutrophil-Lymphocyte-Ratio (NLR) and Platelet-Lymphocyte-Ratio (PLR) as a Biomarker for Distinguishing Between Complicated and Uncomplicated Appendicitis

Rajalingam, Viswa R; Mustafa, Ameer; Ayeni, Adewale; Mahmood, Fahad; Shammout, Sarah; Singhal, Shika; Akingboye, Akinfemi

doi:10.7759/cureus.21446

Cited by 15 publications

(7 citation statements)

References 18 publications

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“…Moreover, it has been proposed to use inflammatory biomarkers such as white blood cell (WBC) count, C-reactive protein (CRP), bilirubin level, immature granulocyte ratio, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) to enable early diagnosis of AA and reduce the rate of misdiagnosis [ 4 , 5 ]. In addition, a study conducted on children revealed that MLR could be used to diagnose AA [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Duyan¹,

VURAL²

2022

Cureus

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BackgroundAcute appendicitis (AA) is one of the most frequent causes of abdominal pain requiring emergency intervention in adults. Approximately one-third of cases present with atypical clinical symptoms. This study aims to compare the monocyte-to-lymphocyte ratio (MLR), red cell distribution width (RDW) to lymphocyte ratio (RLR), and systemic immune inflammation index (SII) with other biomarkers in distinguishing patients with and without AA. MethodologyA total of 347 patients (AA 125, nonspecific abdominal pain 90, and control group 132) were enrolled in the study according to the cross-sectional study design. Receiver operating characteristic (ROC) analysis was used to determine the cutoff in diagnostic value measurements. Statistical significance was determined by the statistics of sensitivity, specificity, positive predictive value, and negative predictive value. Comparison of ROC curves of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil-tolymphocyte ratio (NLR), MLR, and SII was evaluated with the pairwise comparison of ROC curves and 95% confidence interval. ResultsIn detecting AA, CRP, WBC, NEU, NLR, MLR, and SII have excellent diagnostic power (area under the curve [AUC] 0.80-0.88), while RDW, lymphocyte count, monocyte (MON) count, and RLR had acceptable diagnostic power (AUC 0.70-0.77). When the power in the diagnosis of AA was compared, a significant difference was found between CRP and NEU, CRP and SII, WBC and NEU, and WBC and SII. ConclusionsThe diagnosis of AA remains dependent on many factors. Inflammatory biomarkers assist this process. MLR and SII may be recommended to use in diagnosing AA in adults, along with other clinical findings. RLR is adequate but not superior.

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Section: Introductionmentioning

confidence: 99%

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Duyan¹,

VURAL²

2022

Cureus

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“…Delgado y colaboradores 24 , tomaron un punto de corte de INL >8.75 para estimar apendicitis complicada con sensibilidad y especificidad de 75% y 72% respectivamente. Se encontraron puntos de corte de INL inferiores a la presente investigación como el de Rajalingam y colaboradores 25 , que fue de 6.96 para apendicitis complicada, y de 6.17 en el estudio de Ahmad 26 ; en este mismo sentido cabe mencionar los estudios de Khan y colaboradores 27 , que reportaron asociación significativa para apendicitis complicada con un INL >6.36 y el de Jung y colaboradores 28…”

Section: Discussionunclassified

Indice neutrófilo linfocito como marcador de apendicitis aguda complicada en el hospital básico Macará

Guaman

Valdiviezo²,

Carvajal³

2022

Rev. Fac. Cienc. Méd. Univ. Cuenca.

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Introducción: el índice neutrófilo/linfocito (INL) es un marcador sencillo y económico de inflamación subclínica, que se calcula fácilmente a partir de los recuentos diferenciales de glóbulos blancos proporcionando información sobre las vías inflamatorias que pueden convertirlo en un marcador potencial para predecir la apendicitis aguda y su gravedad. Objetivo: determinar la utilidad del INL como marcador de apendicitis aguda complicada en el hospital básico Macará durante el periodo 2018-2021. Metodología: estudio descriptivo basado en historias clínicas de 196 pacientes con diagnóstico de apendicitis aguda confirmada por hallazgo operatorio o histopatológico, en el hospital básico Macará, durante el periodo 2018-2021. Se realizó análisis de las variables estadísticas como edad, sexo, apendicitis aguda no complicada, apendicitis aguda complicada e INL en el programa Epi Info versión 7. Se calculó el chi cuadrado (p <0.05) para la significancia estadística. Resultados: la frecuencia de apendicitis aguda complicada fue del 37%. El promedio de INL fue de 4.93 en apendicitis no complicada (IC 95% 4.34-5.52) y de 13.32 en apendicitis complicada (IC 95% 11.1 – 15.5). El INL > 8.8 resultó ser un factor estadísticamente significativo de apendicitis complicada, con una sensibilidad del 58% y una especificidad del 91%. Conclusiones: el INL resultó un buen indicador para el diagnóstico de apendicitis aguda complicada en el presente estudio.

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“…Clinical scoring systems can predict complicated appendicitis to a certain degree. Similarly, biochemical markers can distinguish between uncomplicated and complicated appendicitis [ 63 , 73 , 74 ]. CT scan findings of complicated appendicitis include Extraluminal appendicolith, abscess, appendiceal wall enhancement defect, extraluminal air, ileus, peri appendiceal fluid collection, ascites, intraluminal air, and intraluminal appendicolith; however, their sensitivity is limited.…”

Section: Reviewmentioning

confidence: 99%

Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review

Echevarria†¹,

Rauf†²,

Hussain³

et al. 2023

Cureus

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Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations.

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The Role of Neutrophil-Lymphocyte-Ratio (NLR) and Platelet-Lymphocyte-Ratio (PLR) as a Biomarker for Distinguishing Between Complicated and Uncomplicated Appendicitis

Cited by 15 publications

References 18 publications

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Indice neutrófilo linfocito como marcador de apendicitis aguda complicada en el hospital básico Macará

Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review

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