The Relationship Between Neutrophil\lymphocyte Ratio and Radial Finding in Acute Appendicitis

Abstract

Abstract

Background & Aim: Acute appendicitis is one of the most common causes of abdominal surgeries. The pre-operatively accurate diagnosis of acute appendicitis can be difficult.

Aim: The aim of this study was to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict acute appendicitis pre-operatively, as well as its relationship with appendix diameter.

Materials and Methods: This cross -sectional study included 128 patients with suspected appendicitis who were admitted to general  surgery department and underwent emergency appendectomy at Al Mouast University Hospital in Damascus, between 2018 and 2019.

According to postoperative histology, patients were divided into two groups: acute appendicitis (positive appendectomy group), and negative appendectomy group (lymphoid hyperplasia is considered as normal appendix). We reviewed the reports of the imaging methods used for the diagnosis. We recorded the appendix diameter in the US and Abdominal CT reports. Measurements > 6 mm were accepted as pathological.

White blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), platelets (PLT) count, and appendix diameter were compared among the groups.

Results: The distribution of Lymphoid hyperplasia and appendicitis rates were statistically different in the groups formed according to appendix diameter (≤ 6 and >6 mm) (p < 0.001), NLR (p=0.039), and WBC (p<0.001).

We found a significant correlation between appendix diameter and NLR                  (r= 0.22, P=0.026).

The sensitivity of to appendix diameter (>6 mm) in the diagnosis of appendicitis in all patients was 91.8% and specificity was 36.7%.

The sensitivity of the NLR score (cutoff = 3.5) in the diagnosis of appendicitis in all patients was 81.5% and specificity was 50% .

When using the cutoff point (4.7) of NLR in patients with appendix diameter > 6 mm, the sensitivity for the diagnosis of appendicitis was 86.7% and specificity was 68.4% .

Conclusion: NLR is an important parameter that may help the diagnosis of acute appendicitis with an appendix diameter of >6 mm.