Preoperative neutrophil-to-lymphocyte ratio may contribute to the prediction of postoperative infectious complications in patients with acute appendicitis: a retrospective study

Abstract

Background Several studies have assessed various clinical variables to identify risk factors for postoperative complications in patients with acute appendicitis. However, few studies have focused on the relationships between systemic inflammatory variables and postoperative complications in patients with acute appendicitis. We investigated the relationships between postoperative complications and systemic inflammatory variables, and assessed the clinical utility of these variables as predictors of postoperative complications in patients with acute appendicitis. Methods We retrospectively reviewed 181 patients who underwent immediate appendectomy for acute appendicitis. All postoperative complications were classified as infectious or noninfectious, and we evaluated the relationships between postoperative complications and clinical factors including the preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Results In total, 28 patients (15.5%) had postoperative Clavien-Dindo grade II–IV complications; 17 patients (9.4%) and 11 patients (6.1%) were categorized as the infectious and noninfectious complication groups, respectively. The cutoff value of the preoperative neutrophil-to-lymphocyte ratio for all complications was 11.3, and multivariate analysis revealed that the preoperative neutrophil-to-lymphocyte ratio was an independent predictor of any postoperative complication (odds ratio: 4.223, 95% confidence interval: 1.335–13.352; P = 0.014). The cutoff value of the preoperative neutrophil-to-lymphocyte ratio for infectious complications was 11.4, and multivariate analysis revealed that the preoperative neutrophil-to-lymphocyte ratio was an independent predictor of infectious complications (odds ratio: 4.235, 95% confidence interval: 1.137–15.776; P = 0.031). Conclusions In patients with acute appendicitis, the preoperative neutrophil-to-lymphocyte ratio may be a useful predictor of all postoperative complications, especially infectious complications.

Preoperative Laboratory Values Predicting Periprosthetic Joint Infection in Morbidly Obese Patients Undergoing Total Hip or Knee Arthroplasty

“…Recently, several studies have demonstrated the potential utility of the NLR, PLR, MLR, and SII in the diagnosis of PJI following TJA [66][67][68][69][70][71][72] . While these inflammatory ratios have been used as predictors of postoperative complications, including infection and mortality, in other surgical specialties, their preoperative utility has yet to be demonstrated in the arthroplasty literature [53][54][55][56][57][58][59][60][61][62][63][64][65] . Our study showed that, among morbidly obese patients who underwent TJA, the risk of PJI increased 2.38-fold if their preoperative NLR was >3.31, 4.86-fold with a PLR of >182.30, and 2.44-fold with an SII above 776.20.…”

“…These values are commonly utilized as screening metrics for patients undergoing TJA and have previously been identified as predictors of postoperative complications following TJA [21][22][23][24]26,27,[43][44][45][46][47][48][49][50][51][52] . The NLR, MLR, PLR, and SII were included to investigate their preoperative utility to predict PJI due to their proven function as diagnostic markers of PJI and as preoperative predictors of complications in other surgical specialties [53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] . Laboratory values were categorized as abnormal using established clinical thresholds.…”

Predictors of Complicated Appendicitis with Evolution to Appendicular Peritonitis in Pediatric Patients

“…The capacity of NLR to distinguish between simple and complicated appendicitis in pediatric patients, as measured by the AUC, ranges from 0.66 to 0.84, with cut-off points between 4.8 and 10.4 and a sensitivity of 67–85% [ 18 ]. Mori et al demonstrated that an increased NLR is a good predictor of postoperative infections in children with acute appendicitis [ 43 ].…”