Abstract
Abstract Introduction: Acute abdominal pain persists in defying modern diagnostic procedures. Inflammatory response variables in urine and blood tests can help rule out other disorders and support a clinical diagnosis of acute appendicitis (AA), but there is no specific blood test that can diagnose AA. In order to address this, our study sought to establish the value of (NLR) as a prognostic and severity predictor in patients with AA. Material and method: We conducted an observational retrospective study of 356 patients who had undergone surgery for AA, assessing NLR as an outcome metric. The NLR was estimated using the differential WBC (white blood count) reported on admission; the data obtained were then recorded in a database and statistically analyzed. Results: The NLR medians correlated (p<0.001) in uncomplicated AA, AA with localized peritonitis, and AA with generalized peritonitis (Kruskal-Wallis test). The ROC curve identified 81.4 % sensitivity, 62.5 % specificity, and a 73 % AUC in localized peritonitis. The NLR value was associated with generalized peritonitis with a sensitivity of 63.7 %, specificity of 64.3 %, and AUC of 68.2%. The NLR-patient death association had 100% sensitivity, 80.3% specificity, and 93.5 AUC. Conclusion: NLR determination in individuals with acute appendicitis may be useful in predicting complications. NLR values greater than 7.86 are usually related with generalized peritonitis, while values larger than 12.9 may predict an increased risk of patient death. Calculating NLR from a complete blood count is a straightforward and cost-effective method of analyzing complicated AA in resource-constrained settings.
Highlights
Acute abdominal pain persists in defying modern diagnostic procedures
neutrophil-to-lymphocyte ratio (NLR) determination in individuals with acute appendicitis may be useful in predicting complications
The diagnosis of acute appendicitis (AA) cannot be made with one specific test, but judicious use of simple urine and blood tests with particular attention to inflammatory response variables can allow for the exclusion of other illnesses and offer additional evidence to support a clinical diagnosis of appendicitis [2, 3]
Summary
Inflammatory response variables in urine and blood tests can help rule out other disorders and support a clinical diagnosis of acute appendicitis (AA), but there is no specific blood test that can diagnose AA. The most common cause of abdominal pain that necessitates surgery is acute appendicitis (AA). Despite multiple modern diagnostic methods, acute abdominal pain continues to present a challenge to rapid and accurate diagnosis, as there are currently no reliable methods of identifying acute appendicitis patients at risk for poor outcomes. Known as secondary peritonitis, is a severe consequence of acute appendicitis caused by gastrointestinal disruption that may result in either localized or diffuse inflammation of the peritoneum and subsequent sepsis [5]. AA is an inflammatory pathology whose onset can mimic other diseases with systemic or abdominal localization and unpredictable evolution [7] This emphasizes the significance of neutrophil-to-lymphocyte ratio NLR as a predictive factor. The aim of the present study was to identify the importance of NLR as a prognostic indicator in patients with AA, and as a severity factor in patients with complicated appendicitis
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