Diagnostic Value of Monocyte-to-Lymphocyte Ratio Against Other Biomarkers in Children With Appendicitis

Abstract

Objectives: This study aimed to investigate diagnostic value of monocyte-tolymphocyte ratio as a novel biomarker in children with appendicitis and to compare with other biomarkers.Methods: A total of 683 children were included in this retrospective study.Patients were categorized as acute appendicitis (AA, n = 254), perforated appendicitis (PA, n = 82), nonspecific abdominal pain (NAP, n = 197), and control (n = 150). The groups were compared for demographics, duration of symptoms, monocyte-to-lymphocyte ratio (MLR), platelet-tolymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), white blood cell count, neutrophil percentage (NP), C-reactive protein (CRP), mean platelet volume, and sodium level.Results: There was a significant difference between all groups for MLR, PLR, and CRP. White blood cell count, NP, and NLR were significantly increased in patients with appendicitis, but there was no significant difference in the differential diagnosis between PA and AA. Sodium levels significantly decreased in patients with appendicitis. No statistically significance was determined between all groups in term of mean platelet volume. Among the biomarkers, MLR showed the highest diagnostic value (area under the receiver operator characteristic curve = 0.798) for AA, while CRP showed excellent diagnostic value (area under the receiver operator characteristic curve = 0.897) for PA.Conclusions: To our knowledge, this is the first study showing that MLR is a valuable parameter to differentiate patients with and without appendicitis. White blood cell, NP, and NLR are also useful parameters. On the other hand, an increased CRP level and hyponatremia are indicators of PA.

Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

“…Out of forty-three remaining abstracts, thirty-five were excluded. Only eight full-texts were assessed for eligibility [ 10 , 11 , 17 , 18 , 19 , 20 , 21 , 22 ]. One of them was further excluded as it had not reported the exact sodium levels [ 22 ].…”

“…One of them was further excluded as it had not reported the exact sodium levels [ 22 ]. Therefore, only seven studies were included in the final meta-analysis [ 10 , 11 , 17 , 18 , 19 , 20 , 21 ]. Five of these seven studies had a retrospective study design [ 17 , 18 , 19 , 20 , 21 ].…”

“…Therefore, only seven studies were included in the final meta-analysis [ 10 , 11 , 17 , 18 , 19 , 20 , 21 ]. Five of these seven studies had a retrospective study design [ 17 , 18 , 19 , 20 , 21 ]. The baseline characteristics of the included studies are depicted in Table 1 .…”

“…This non-osmotic release of ADH leads to excess free water reabsorption in the kidneys and causes dilutional hyponatremia. Some recently published studies investigated hyponatremia as a novel diagnostic marker of complicated appendicitis [ 10 , 11 , 17 , 18 , 19 , 20 , 21 ].…”

Mean Platelet Volume in the Diagnosis of Acute Appendicitis in the Pediatric Population: A Systematic Review and Meta-Analysis

“…This retrospective study was conducted in Turkey. The sample size included 254 patients with AA, 197 with non-AA, and 150 controls [ 24 ]. The study found no significant difference in the mean platelet volume (MPV) between the groups.…”