The Role of Inflammatory Ratios: Neutrophils to Lymphocytes Ratio, Platelet to Lymphocyte Ratio, and C-reactive Protein to Platelets Ratio in Diagnosis of Acute Appendicitis and Its Severity

Abstract

Background: Acute appendicitis is one of the most common surgical emergencies encountered in clinical practice. New inflammatory markers, named neutrophils/lymphocytes ratio (NLR), platelet/ lymphocyte ratio (PLR), and C-reactive protein /platelets ratio (CRP/PLT), have been implemented recently in clinical practice for the diagnosis and assessment prognosis of many conditions like malignancies, cardiovascular diseases, and end-stage renal disease. However, none of those markers have been well studied in acute appendicitis. In this article, the role of NLR, PLR, and CRP/PLT in diagnosing acute appendicitis and the correlation of their values to the severity of the disease has been studied. Methods: A retrospective study was conducted on 346 patients of all ages and genders who were admitted to Al-Makassed Islamic Charitable Hospital in Palestine for three years, from 2018 to 2021, with the diagnosis of acute appendicitis. Complete blood count and CRP were reviewed. NLR, PLR, and CRP/PLT ratios were calculated and compared between divided groups according to the age and severity of the disease. A T-test was used for the analysis of the results. Results: Neither NLR nor PLR showed a statistically significant association with the diagnosis of acute appendicitis or prediction of its severity. Regarding CRP/PLT ratio, it was 0.202±0.431in the pediatric group who were diagnosed with acute appendicitis and 0.039±0.061 in the pediatric group who had normal appendix (P value of 0.029), while it was 0.194±0.316 in adult appendicitis group and 0.107±0.132 in an adult group with normal appendix (P value of 0.567). The CRP/PLT ratio in the pediatric group who had uncomplicated acute appendicitis was 0.186±0.452 compared to 0.305±0.323 in complicated appendicitis (P value of 0.001), while the ratio in the adult simple appendicitis group was 0.154±0.293 compared to complicated cases that were 0.426±0.345 (P value of <0.001). Conclusion: Based on a complete analysis of the novel inflammatory markers in the two age groups, pediatrics, and adults, in both simple and complicated acute appendicitis, only the CRP/PLT ratio showed high accuracy for diagnosis of acute appendicitis in pediatrics and distinguishing complicated cases from simple ones in both pediatric and adult age groups.