Evaluation of diagnostic value of neutrophil to lymphocyte ratio in younger and older pediatrics suspect to acute appendicitis in Imam Hossein hospital

Abstract

Introduction: Acute appendicitis in children is the most common acute surgical condition in children. Each year, 80000 children in the United States suffer from appendicitis. Objectives: The aim of this study was to evaluate diagnostic value of neutrophil to lymphocyte ratio (NLR) in younger and older pediatrics suspect of acute appendicitis in Imam Hossein hospital. Patients and Methods: This was a retrospective study conducted at Imam Hossein hospital from 2015-2017. The study population was all children with suspected appendicitis who refer to Imam Hossein medical center in Isfahan. The sample size was 423 people. The collected data were imported into SPSS software version 22 and analyzed with appropriate statistical tests. The significance level in the present study was less than 0.05. Results: The average age of participants was 7.2 ± 3.8 years. In both study groups, it was observed that the mean NLR in the normal and reactive follicular groups was significantly lower than the appendicitis and complication groups (P<0.05). The results of the present study showed that NLR diagnostic test can be a good predictor for the evaluation of appendicitis in both groups under 4 years and over 4 years. For more than 4 years’ group; AUC=0.74, P<0.001 and for less than 4 years’ group; AUC=0.69, P<0.001. For less than 4 years’ group, the cut-off score for appendicitis diagnosis was 2.3. In this cut-off, the sensitivity and specificity were equal to 0.65% and 0.72%. Additionally, for more than 4 years’ group, the cut-off for the diagnosis of appendix was 3.5. In this cut-off, the sensitivity and specificity were equal to 0.73% and 67%. Conclusion: This analysis demonstrates that NLR, in the context of appropriate clinical assessment of patients with a high a priori probability of appendicitis, has a greater diagnostic accuracy in supporting the diagnosis of appendicitis.