Abstract
Aim of the study: Postoperative intra-abdominal abscess (PIAA) is a frequent and severe complication of acute appendicitis (AA) with peritonitis. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that has been related to the development of peritonitis; however, its diagnostic role in predicting PIAA has not been evaluated. This is the first study that analyzes the usefulness of NLR as a predictor of PIAA in children operated for AA.Material and Methods: Retrospective observational study in children operated for AA in our institution during 2017–2018. Patients aged under 5 years or with incomplete laboratory determinations at hospital admission (blood count, C-reactive protein, and fibrinogen) were excluded. Demographic and laboratory parameters and the development of PIAA were analyzed. NLR was calculated by dividing the absolute number of neutrophils by the absolute number of lymphocytes. By means of ROC curves, we determined the sensitivity and specificity of the different laboratory parameters to predict the development of PIAA.Results: A total of 388 patients aged 10.5 ± 2.9 year were included. Twenty (5.2%) developed PIAA. NLR presented an area under the curve (AUC) of 0.85, significantly higher than the determination of leukocytes (AUC 0.69, p < 0.001), neutrophils (AUC 0.74, p < 0.001), fibrinogen (AUC 0.68, p < 0.001) and C-reactive protein (AUC 0.73, p < 0.001). We estimated the optimal cut-off point of NLR > 10.5, with a sensitivity of 85% and a specificity of 75.2%.Conclusions: NLR is the laboratory parameter with the highest sensitivity and specificity for predicting the development of PIAA in children operated for AA. It can be useful as a predictor of worse postoperative course.
Highlights
Acute appendicitis (AA) is the most frequent surgical emergency in all age groups [1], with an estimated annual incidence of 100 per 100,000 inhabitants, with an overall risk of 8.6% for men and 6.7% for women [2]
High values of leukocytes, neutrophils, percentage of neutrophils and eosinophils were observed in the group of patients who presented PIAA, that were significantly higher than in patients without PIAA
neutrophil-to-lymphocyte ratio (NLR) was significantly higher in patients with PIAA (15.6 ± 5.5 vs. 8.3 ± 5.8; p < 0.001)
Summary
Acute appendicitis (AA) is the most frequent surgical emergency in all age groups [1], with an estimated annual incidence of 100 per 100,000 inhabitants, with an overall risk of 8.6% for men and 6.7% for women [2]. Its diagnosis depends to a great extent on the clinical assessment of the surgeon, in the pediatric age it is often difficult to make an early diagnosis, Neutropthil-to-Lymphocyte Ratio and Postsurgical Intraabdominal Abscess due to the difficulties of doctor-patient communication and the absence of classic symptoms [3]. Patients who undergo appendectomy for complicated appendicitis are more likely to develop post-operative complications, such as wound infection or intra-abdominal abscess (PIAA). It is estimated that PIAA can complicate up to 4.2% of non-perforated acute appendicitis [5] and between 6.7 to 28% of perforated appendicitis [6]. PIAAs entail a significant increase in morbidity and mortality [7, 8] and are responsible for longer hospitalizations and/or re-admissions [9]
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