Role of Neutrophil to Lymphocyte Ratio in Diagnosis and Prediction of Complications of Acute Appendicitis

Abstract

Acute appendicitis is one of the most common surgeries which is done rgently. Distinguishing complicated and non-complicated appendicitis entities can influence on decision-making of the surgeon about the timing of the surgery and the approach of surgery. Role of hematologic indices has been investigated recently. This thesis evaluates the role of these indices, especially neutrophil to lymphocyte ratio, to study the prediction of mplication in acute appendicitis. Method: The patients who underwent appendectomy in two training hospitals during 2019 to 2021 have been studied. The age, symptom duration, laboratory and imaging findings and pathologic reports of 568 patients were recorded. Patients were categorized in complicated and non-complicated appendicitis groups due to their pathologic reports. The mentioned arameters were compared between these groups via t-test or Mann-Whitney test, depending on normality or abnormality of probability distribution. Then analysis of ROC was done to find the cut-off point for variables and estimate diagnostic accuracy of laboratory and imaging finding in distinguishing complicated appendicitis from the other group. And the comparison was made. Results: The mean age of the patients (51.4% male, 48.6% female) was 31.2 and the median was 28. Complicated appendicitis was reported in 43% of patients. WBC, neutrophilo lymphocyte ratio(NLR) and platelet to lympho- III cite ratio (PLR) was higher in complicated appendicitis group (p<0.001). The ROC curve showed than AUC, cut-off point, sensitivity and specificity was respectively 61, 9.65, 88.1% and 34.5% for WBC, 0.67, 5.16, 78.1% and 51.8% for NLR and 0.6, 118.4, 70.8% and 49.3% for PLR. The sensitivity and specificity of imaging findings to predict complicated appendicitis was 21.2% and 89.2%, respectively.