Neutrophil-to-lymphocyte ratio to improve the diagnostic performance of appendicitis inflammatory score and modified Alvarado score

Abstract

Abstract: BACKGROUND: Acute appendicitis is a surgical emergency often encountered in clinical practice. Diagnosis is usually based on clinical judgment supplemented with a few baseline investigations. Neutrophil-to-lymphocyte ratio (NLR) is a novel, stable inflammatory marker reflecting the inflammatory status, superior to individual leukocyte parameters. OBJECTIVES: We aimed to study the introduction of NLR as an additional parameter in the appendicitis inflammatory score and modified the Alvarado score to improve the sensitivity and specificity in the diagnosis of acute appendicitis. MATERIALS AND METHODS: This was a retrospective study of clinical and laboratory data of 101 consecutive patients above the age of 18 years with a sudden onset of nontraumatic abdominal pain and a provisional clinical diagnosis of uncomplicated acute appendicitis, subsequently undergoing appendectomy. Findings on histopathological examination of the resected appendix were considered the gold standard. The NLR was calculated from the hemogram parameters for all patients. The receiver operating characteristic (ROC) curve was used to determine the threshold score levels and the performance characteristics of scoring systems. RESULTS: The median age was 27 (12.50) years, with male predominance (77.2%). The appendicitis inflammatory response (AIR) score, modified Alvarado score, and the NLR were all significantly higher among patients with histopathologically confirmed appendicitis (P < 0.01). A new score developed by combining the NLR with the AIR score outperformed both the modified Alvarado score and the original AIR score, as evident by significant increase in the area under the ROC curve. NLR is a useful parameter, and its addition to the AIR score can help guide clinical management. CONCLUSION: The addition of NLR in AIR score can help in clinical management of appendicitis.