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

Adewale Ayeni; Fahad Mahmood; Ameer Mustafa; Bethan Mcleish; Vaibhavi Kulkarni; Shika Singhal; Akinfemi Akingboye

doi:10.7759/cureus.28619

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

Cureus. 2022 Aug 31;14(8):e28619. doi: 10.7759/cureus.28619. eCollection 2022 Aug.

Authors

Adewale Ayeni¹, Fahad Mahmood², Ameer Mustafa¹, Bethan Mcleish³, Vaibhavi Kulkarni⁴, Shika Singhal⁵, Akinfemi Akingboye⁶

Affiliations

¹ General Surgery, Russells Hall Hospital, Dudley, GBR.
² General Surgery, Walsall Manor Hospital, Walsall, GBR.
³ Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR.
⁴ Surgery, The Dudley Group NHS Foundation Trust, Dudley, GBR.
⁵ Pathology, Royal Wolverhampton Hospital, Wolverhampton, GBR.
⁶ Colorectal Surgery, Russells Hall Hospital, Dudley, GBR.

Abstract

Introduction 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 methods This 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. Results A 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. Conclusions NLR and PLR are reliable, synergistic markers predicting complicated appendicitis which can guide non-operative management in children.

Keywords: acute appendicitis; appendectomy; biomarker; children; complicated appendicitis; inflammation; neutrophil-lymphocyte; platelet-lymphocyte; surrogate marker; uncomplicated appendicitis.