The Utility of Neutrophil-to-Lymphocyte Ratio as a Severity Predictor of Acute Appendicitis, Length of Hospital Stay and Postoperative Complication Rates

Abstract

Background: Numerous screening tools have been reported to aid in diagnosing appendicitis, but have poor severity prediction and lack accurate estimation of postoperative complications or total length of hospital stay (LOS). Aim: This study aims at evaluating the utility of neutrophil-to-lymphocyte (NLR) ratio in predicting the severity of appendicitis, LOS and 30-day complication rates. Methods: Patients who underwent appendicectomy over a 4-year period were evaluated. Demographics, blood results, severity of appendicitis, LOS and 30-day complications were recorded. Recommended cut-off values of NLR and C-reactive protein (CRP) for severity of appendicitis were determined using receiver operating characteristic analysis. The Mann-Whitney test was performed to assess the correlations between LOS and 30-day complications with NLR. Results: A total of 663 patients were included in the study of which 57.3% (n = 380) were male with mean patient age of 23.6 years, and 461 appendix specimens (69.6%) had simple inflammation on histological evaluation. A NLR of >6.35 or CRP of >55.6 were statistically associated with severe acute appendicitis, with a median of one extra hospital day admission (p < 0.0001). Mean NLR was statistically higher in patients with postoperative co(13.69 for severe vs. 7.29 for simple appendicitis group, p = 0.016). Conclusion: We advocate that NLR is a useful adjunct in predicting severity of appendicitis. It aids in delineating severe inflammation requiring surgery without substantial delay.

Investigation of the Diagnostic Value of Neutrophil to Lymphocyte Ratio in Pediatric Appendicitis Cases

“…According to their data, NLR was a good indicator to predict severity of appendicitis and estimate the length of the stay time; cutoff value was higher in the pediatric population (7.53, sensitivity: 80%, specificity: 55%) compared with that of the adults (6.35, sensitivity: 85%, specificity: 48%) (19). The current study did not evaluate the severity of appendicitis, but there was no difference in the length of stay between the AA and NA groups.…”

The Utility of Neutrophil to Lymphocyte Ratio as a Predictor of Intervention in Acute Diverticulitis

“…A retrospective study of 663 patients with acute appendicitis from our institution demonstrated that an NLR value of >6.35 was associated with severe acute appendicitis and a prolonged hospital stay [10] . Similarly, Beecher et al [16] demonstrated that an NLR >5.47 was more accurate than CRP and WBC at detecting complicated acute appendicitis.…”

“…Neutrophil to lymphocyte ratio (NLR) is a relatively novel biomarker that has been studied in the setting of surgical oncology, acute appendicitis and acute pancreatitis among other conditions [9][10][11] . The principle behind NLR is that neutrophil levels rise as part of the inflammatory cascade, whereas lymphocytes are depleted during sepsis.…”

Alvarado and Appendicitis Inflammatory Response Scores Can Evaluate Severity of Acute Appendicitis?

“…The white blood cell (WBC), CRP, and total bilirubin values, the neutrophil-to-lymphocyte ratio, and the combination of radiology and laboratory scoring systems are used for severity evaluation. [8][9][10][11][12] The AS and the AIRS were designed to help diagnose AA. The aim of this study was to retrospectively assess use of the AS and the AIRS to evaluate severity of appendicitis.…”