The role of neutrophil-albumin ratio in the diagnosis of acute appendicitis and its efficacy in predicting perforation

Ulus Travma Acil Cerrahi Derg. 2022 Dec;29(1):52-58. doi: 10.14744/tjtes.2022.56570.


Background: Acute appendicitis (AA) is one of the most common causes of abdominal pain in patients presenting to the emergency department with abdominal pain, and despite developments in radiological imaging for its diagnosis, researchers are still in pursuit of a simpler, cheaper, and safer biomarker. Our study investigated the usability of the neutrophil-albumin ratio, a biomarker that predicts prognosis in cases with severe inflammation, in diagnosing AA and anticipating perforation.

Methods: Our study is a retrospective and cross-sectional study. The study was conducted with patients who presented to the emergency department between January 2018 and December 2020 and were hospitalized with a preliminary diagnosis of AA. The cases were first divided into two groups as 'Not appendicitis' and 'AA,' and then the patients with 'AA' were divided into two subgroups as 'Perforated' and 'Non-perforated.' The demographic data of the patients, their symptoms, physical examination findings, and the decision-making process for surgery were noted. The neutrophil count and albumin levels detected in the blood samples obtained at the time of admission to the emergency department were noted. Afterward, the neutrophil-albumin ratio (NAR) was calculated and the cutoff level was determined to predict the diagnosis of AA and the development of perforation.

Results: The rate of complaints of pain in the periumbilical region was significantly higher in the patient group without AA compared to the patients in the AA group (70.6% and 40.3%, p=0.034). Although the leukocyte count, neutrophil count and percentage, and NAR were significantly higher in the AA group, the lymphocyte count was found to be significantly lower (p=0.005). However, no significant correlation was found between the NAR and the development of perforation (p=0.697).

Conclusion: The NAR is useful for the diagnosis of AA. Nevertheless, it is not a sufficient biomarker for detecting perforation.

MeSH terms

  • Abdominal Pain
  • Acute Disease
  • Albumins
  • Appendicitis* / surgery
  • Biomarkers
  • C-Reactive Protein / analysis
  • Cross-Sectional Studies
  • Humans
  • Leukocyte Count
  • Neutrophils*
  • Retrospective Studies


  • Biomarkers
  • Albumins
  • C-Reactive Protein