Direct bilirubin to lymphocyte ratio can discriminate acute appendicitis and ovarian torsion: a comparative study.

Abstract

In this study, we aimed to determine whether a patient presenting to the emergency room with abdominal pain and for whom ultrasound access is challenging until an ultrasound is performed, is suffering from ovarian torsion or acute appendicitis. We sought to make this determination based on hematological indices and to investigate the diagnostic value of the direct bilirubin-to-lymphocyte ratio (DLR) in this context. This study encompasses female patients who presented with abdominal pain to Çam and Sakura Training and Research Hospital between the years 2015 and 2023 and were diagnosed with either acute appendicitis or ovarian torsion. Patients' files were screened retrospectively. Key information, including patients' ages, the onset time of symptoms (duration of symptoms), and laboratory values, was meticulously recorded. The patients were divided into two groups: those with ovarian torsion (Group 1) and those with acute appendicitis (Group 2). The study comprised two distinct patient groups with a total of 159 patients: Group 1 (n=57), representing ovarian torsion, and Group 2 (n=102) representing acute appendicitis. No differences were found in terms of age, symptom duration, White Blood Cell (WBC) Count, Platelet (PLT), CRP (C-reactive protein), and Platelet-to-lymphocyte ratio (PLR) (p>0.05 for each comparison). Direct bilirubin (DB), indirect bilirubin (IB), and total bilirubin (TB) were higher in Group 2 than in Group 1 (p=0.011, p<0.001, p=0.044, respectively). Neutrophil-to-Lymphocyte Ratio (NLR) and Direct Bilirubin-to-Lymphocyte Ratio (DLR) were higher in Group 2 than in Group 1 (p=0.013, p=0.002, respectively). The NLR was analyzed with a cut-off value of 4.1 (AUC: 0.642; sensitivity 82%, specificity 52%). The PLR was analyzed with a cut-off value of 116 (AUC: 0.670; sensitivity 92%, specificity 42%). The DLR was analyzed with a cut-off value of 0.14 (AUC: 0.741; sensitivity 93%, specificity 55%). This research highlighted the potential of the DLR index in differentiating between ovarian torsion and acute appendicitis, revealing that DLR levels were notably higher in appendicitis patients.