Preoperative neutrophil-to-lymphocyte ratio in predicting the severity of appendicitis: A retrospective cohort study in a tertiary rural hospital
Journal Title: International Journal of Surgery Science - Year 2018, Vol 2, Issue 4
Abstract
Acute appendicitis (AA) is one of the most common acute surgical conditions of the abdomen, and has a lifetime risk of approximately 7%. Although urgent appendectomy is still considered the gold standard treatment, recent evidence has shown that AA can be treated conservatively without surgery. However, conservative treatment is likely inconvenient in cases of perforated AA. Therefore, any factor that allows for prediction of perforation in AA contributes significantly to patient-specific treatment. Furthermore, relatively troublesome operation, including the selection of laparoscopy or laparotomy, etc. The Neutrophil-to-Lymphocyte ratio is derived from the counts of circulating neutrophils and lymphocytes, both of which are major leukocyte subpopulations. The inflammation-triggered release of arachidonic acid metabolites and platelet-activating factors results in neutrophilia, and cortisol-induced stress results in relative lymphopenia, and thus, the Neutrophil-to-Lymphocyte ratio accurately represents the underlying inflammatory process. AIM: The aim of the present study was to evaluate the predictive value of simple laboratory parameters including white cell count (WCC), NLR in the diagnosis of acute appendicitis and its complications. Materials and Methods: Records of 514 patients who underwent open or laparoscopic appendectomy between March 2013 and July 2013 at R L Jalappa hospital, Tamaka, kolar were reviewed retrospectively. Demography, recorded anamneses, histopathological findings, and preoperative NLR was calculated. Results: White cell count (WCC) and NLR were significant parameters for the diagnosis of acute appendicitis. Cut-off values were 11900/mm3 for WCC (sensitivity: 71.2%; specificity: 67.2%; OR: 5.13) and 3.0 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 4.27). NLR was an independent variable for the diagnosis of perforated appendicitis. Cut-off value was 4.8 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 2.6). Conclusion: In conclusion, it was demonstrated that no simple yet perfect test currently exists for diagnosing acute appendicitis and recognizing perforation. However, increases in WCC, serum bilirubin level, and NLR can be considered moderately reliable indicators for the diagnosis of acute appendicitis. Serum bilirubin level and NLR are useful indicators for the recognition of perforated appendicitis.
Authors and Affiliations
Shashirekha CA, Rahul Singh R, Spurthi Sanganboina, Krishna Prasad K, Sreeramulu PN
Keywords
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Preoperative neutrophil-to-lymphocyte ratio in predicting the severity of appendicitis: A retrospective cohort study in a tertiary rural hospital
Acute appendicitis (AA) is one of the most common acute surgical conditions of the abdomen, and has a lifetime risk of approximately 7%. Although urgent appendectomy is still considered the gold standard treatment, recen...