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

[Inflamatory indexes predictors of complicated acute apendicitis in children]

Background

Appendicitis is the main cause of acute surgical abdomen in pediatrics. Delay in the diagnosis implies serious consequences.

Objective

To know the utility of inflammation markers for predicting complicated acute appendicitis (CAA) in children.

Material and methods

Analytical cross-sectional retrolective study. We included patients from 3 to 17 years, with and without acute appendicitis (AA), who had complete blood count (CBC). Presurgical CBC, surgical findings and histopathologic results were recorded; group I, CAA; group II, uncomplicated acute appendicitis (UAA); and group III, without AA, with stratified analysis by age group.

Results

377 patients were included, 9 years of age (IQR 5-12.5), group I (n = 94), group II (n = 94) and group III (n = 189). Group I showed elevation in the values of Neutrophil/lymphocyte ratio (NLR), Platelet/lymphocyte ratio (PLR) and Systemic immune inflammation (SII) index and lower levels for the Lymphocyte/monocyte ratio (LMR). For AA, in preeschoolers, NLR (sensitivity [S]: 0.85; specificity [E]: 0.98), PLR (S: 0.76; E: 0.85), SII (S: 0.92; E: 0.92) was observed; school children, NLR (S: 0.90; E: 0.96), PLR (S: 0.70: E: 0.86), SII (S: 0.91; E: 0.91); adolescents, NLR (S: 0.85; E: 0.97), PLR (S: 0.26; E: 0.95), SII (S: 0.86; E: 0.86); in CAA, S and E decreased. NLR, PLR, LMR and SII were associated with AA in all ages; PLR and SII in preschoolers, LMR in school children were associated with CAA.

Conclusion

NLR, PLR, LMR and SII are predictors of AA in pediatric age, and for AAC, PLR and SII in preschoolers and LMR in school children.

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

OBJECTIVE

 Investigate the potential use of the neutrophil-to-lymphocyte ratio (NLR) in the identification and differentiation of acute appendicitis patients, specifically between simple and complicated presentations.

METHODS

 An observational retrospective cohort study was conducted in Aseer Central Hospital, Saudi Arabia.

RESULTS

In total, 103 patients were included in this study, in which males (50.5%) were more common than females (49.5%), and the most common age group was found to be 36-45 years (56.3%), followed by 18-25 years (23.3%). All patients (100%) had a diagnosis of acute appendicitis. The means of neutrophils, lymphocytes, and NLR were found to be 68.970%, 22.067%, and 5.020, respectively. The majority (69%) had non-complicated appendicitis, while (31%) had complications. A significant association was seen between NLR and the occurrence of complications (p-value = 0.00001).

CONCLUSION

This study can comprehensively support the evidence presented in the literature review. The use of the NLR demonstrates a notable level of accuracy in diagnosing acute appendicitis and differentiating between complex and uncomplicated cases.