Could the neutrophil-to-lymphocyte ratio serve as a marker in the diagnosis and prediction of acute appendicitis complications in children?

Sadeta Begic-Kapetanovic; Nesina Avdagic; Asija Zaciragic; Sabaheta Hasic; Nermina Babic; Adnan Hadzimuratovic

doi:10.5114/aoms.2019.87697

Could the neutrophil-to-lymphocyte ratio serve as a marker in the diagnosis and prediction of acute appendicitis complications in children?

Arch Med Sci. 2019 Sep 9;17(6):1672-1678. doi: 10.5114/aoms.2019.87697. eCollection 2021.

Authors

Sadeta Begic-Kapetanovic¹, Nesina Avdagic², Asija Zaciragic², Sabaheta Hasic³, Nermina Babic², Adnan Hadzimuratovic⁴

Affiliations

¹ Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.
² Department of Human Physiology, Faculty of Medicine University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
³ Department of Biochemistry, Faculty of Medicine University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁴ Clinic of Surgery Karabeg, Sarajevo, Bosnia and Herzegovina.

Abstract

Introduction: Acute appendicitis (AA) is the most common surgical condition of the abdomen in children. The aim of this study was to analyse the possible use of the neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and prediction of AA complications in children.

Material and methods: We included 170 AA patients under 15 years of age, who were divided into the following groups: Group 1 - non-operated patients with AA, and Group 2 - patients who underwent appendectomy. Based on pathologic grades of AA, Group 2 was subdivided into: Group A - phlegmonous, Group B - gangrenous, and Group C - perforated AA. NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count.

Results: In Group 2 NLR was significantly higher than in Group 1 (5.5 (1.9-9.9) vs. 2.3 (1.2-3.7); p < 0.001). A significant difference in NLR was found between Group C and Group A (p < 0.001), and as well as between Group B and Group A (p = 0.001). The determined optimal cut-off value of NLR in differentiating Group 1 vs. Group 2 was ≥ 3.48 (p < 0.001). In differentiating Group A from Group C the optimal cut-off value of NLR was ≥ 5.61 (p < 0.001). Furthermore, optimal cut-off value of NLR in differentiating Group A from Group B was ≥ 5.45 (p = 0.001).

Conclusions: The obtained results suggest that NLR could be used as a simple and reliable test in the diagnosis and prediction of AA complications in children. However, to draw definite conclusions on the predictive power of NLR as a marker of AA large multicentric studies are required.

Keywords: acute appendicitis; children; neutrophil-to-lymphocyte ratio.