The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review

Abstract

Background: To date, no parameter with satisfactory accuracy exists for the diagnosis of appendicitis. This retrospective study describes the discriminatory value of preoperative hematologic factors associated with complicated and non-complicated pediatric appendicitis. Methods: Clinical and laboratory data were obtained from 294 children diagnosed with appendicitis on admission and treated at our tertiary-level pediatric hospital from 2015 to 2017; they were divided into three groups: control group (n Z 118), histologically proven complicated (n Z 120), and non-complicated (n Z 56) appendicitis. Results: Complicated appendicitis was associated with male preponderance and elevated neutrophil and monocyte levels (all p < 0.001). Non-complicated appendicitis was associated with elevated eosinophil levels (p Z 0.023), and unaltered lymphocyte levels (p Z 0.30). Compared to non-complicated disease, the lymphocyte-to-monocyte ratio (LMR) was decreased in complicated appendicitis (p Z 0.003) but unaltered in the control group (p Z 0.38). In the discrimination analysis, LMR had high accuracy (AUC 0.73 AE 0.05; p < 0.001; odds ratio (OR) (95% confidence interval (CI)) 6.0 (2.4e15.3)) and was the only parameter independently associated with complicated appendicitis on regression analysis (OR (95% CI), 0.544 (0.359e0.825); p Z 0.004). Conclusion:We identified LMR as a novel potential marker for the differentiation of complicated from non-complicated pediatric appendicitis. This has implications on the treatment approach, either surgical in complicated disease or conservative in non-complicated disease.

Drug‐resistant seizures associated with hyperinflammatory monocytes in FIRES

“…In agreement with the clinical measurements, prior to seizure resolution (draw 1) the patient had a large neutrophil and monocyte burden coupled to low lymphocyte counts (Table 1). Indeed, the neutrophil‐to‐lymphocyte ratio 30–32 at this timepoint was nearly 15 and the monocyte‐to‐lymphocyte ratio 33,34 was over two, indicative of profound systemic inflammation. Both ratios were reduced by draw 2 and remained within or near normal range over subsequent draws.…”

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

“…There are different cytokine profiles associated with the upregulation of monocytes and neutrophils in complicated appendicitis and the upregulation of basophils and eosinophils in non-complicated appendicitis [ 35 ]. Platelets are key factors in the thrombo-inflammatory response and interact with leukocytes and monocytes, promoting cell signaling, migration, and even cell phenotypic changes [ 36 ]. Large and active platelets are more susceptible to being sequestered and consumed at sites of inflammation, conducting to a lower platelet count in sepsis and other severe types of inflammatory processes such as perforated appendicitis [ 17 ].…”

The Use of Inflammatory Markers to Rule Out Acute Appendicitis in Pediatrics

“…There are multiple new studies looking at other inflammatory markers to help diagnose acute appendicitis; for example, the study by Bozlu looked at the red blood cell distribution width in combination with WBC and CRP with no clear role in ruling out appendicitis [ 12 ]. Another study by Nissen looked into the lymphocyte-to-monocyte ratio to differentiate complications with non-complicated appendicitis; their role in ruling out appendicitis is not yet clear [ 13 ]. Looking into the scoring system as the solo method for ruling out appendicitis, multiple studies were done discussing score validation.…”