Use of Neutrophil/Lymphocyte Ratio in Diagnosis of Phlegmonous Appendicitis

Abstract

Purpose: The diagnosis of appendicitis usually based on the clinical findings. Some laboratory tests may be helpful in diagnosis. White blood cell (WBC) count is not sensitive or specific in the diagnosis of acute appendicitis and it could not be considered as a reliable test for deciding surgery. In this study, we aimed to evaluate if the neutrophil/lymphocyte ratio (NLR) is superior to WBC in detecting the severity of the inflammation. Methods: A total of 153 patients operated for acute appendicitis were included into the study. Preoperative clinical and laboratory parameters of the patients were recorded and these were then compared to postoperative histology. Diagnosis was stratified into three groups according to pathology reports (normal histology, acute appendicitis, phlegmonous appendicitis). Receiver operating characteristics (ROC) curve analysis was made to determine the discriminatory ability of NLR. A threshold NLR value for phlegmonous appendicitis was 8. Results: A total of 153 patients (14 female and 139 male) were operated for acute appendicitis between January, 2012 and February, 2013. Median age was 22 years with a range of 17-83 years. The ratio of negative appendectomy was 8.5% (13 patients) according to histopathologic examination. The area under ROC curve for NLR was 0.923, compared to 0.667 for WBC and 0.881 for percent of neutrophils. The sensitivity and specificity of NLR with a threshold of 8 were 100% and 81.6%, respectively. Conclusion: The results of this study suggest that NLR may provide more helpful information than WBC or percent of neutrophils in the complete blood count.