The role of neutrophil-to-lymphocyte ratio as an outcome predictor factor in acute appendicitis: a single medical center’s experience

Abstract

Introduction: Acute abdominal pain persists in defying modern diagnostic procedures. Inflammatory response variables in urine and blood tests can help rule out other disorders and support a clinical diagnosis of acute appendicitis (AA), but there is no specific blood test that can diagnose AA. In order to address this, our study sought to establish the value of (NLR) as a prognostic and severity predictor in patients with AA. Material and method: We conducted an observational retrospective study of 356 patients who had undergone surgery for AA, assessing NLR as an outcome metric. The NLR was estimated using the differential WBC (white blood count) reported on admission; the data obtained were then recorded in a database and statistically analyzed. Results: The NLR medians correlated (p<0.001) in uncomplicated AA, AA with localized peritonitis, and AA with generalized peritonitis (Kruskal-Wallis test). The ROC curve identified 81.4 % sensitivity, 62.5 % specificity, and a 73 % AUC in localized peritonitis. The NLR value was associated with generalized peritonitis with a sensitivity of 63.7 %, specificity of 64.3 %, and AUC of 68.2%. The NLR-patient death association had 100% sensitivity, 80.3% specificity, and 93.5 AUC. Conclusion: NLR determination in individuals with acute appendicitis may be useful in predicting complications. NLR values greater than 7.86 are usually related with generalized peritonitis, while values larger than 12.9 may predict an increased risk of patient death. Calculating NLR from a complete blood count is a straightforward and cost-effective method of analyzing complicated AA in resource-constrained settings.