Using neutrophil-lymphocyte ratio, mean platelet volume, and hyponatremia to diagnose appendicitis in children

Abstract

Background: Acute appendicitis is one of the common reasons for acute abdominal pain among children. The diagnosis of appendicitis in children is always challenging. There is a failure to improve morbidity and mortality related to appendicitis, even after advancements in imaging modalities. Therefore, there is a need for markers to help in the diagnosis process. This study aimed at finding if neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), and hyponatremia are helpful tools to diagnose acute appendicitis and whether they can be beneficial in distinguishing complicated from uncomplicated appendicitis among children. Methods: This cross-sectional study was conducted on the pediatric population who were diagnosed with acute appendicitis and treated as an inpatient in the Ministry of Health Hospitals in Abha and Khamis Mushayt. The data of patients were collected using a data collection sheet. Statistical analysis was conducted using the Statistical Package for the Social Sciences software. Results: Among 384 children with appendicitis; 72.9% had an uncomplicated acute appendectomy, and 27.1% had a complicated condition. NLR significantly increased among complicated cases (p < 0.001), whereas MPV and sodium levels were increased among uncomplicated patients (p < 0.001). The logistic regression model showed that NLR was a predictor for complicated appendicitis (p = 0.031, OR = 1.066; CI 1.006-1.129), whereas regarding increased levels of MPV and sodium, it was found that p = 0.009, OR = 0.794; CI 0.668-0.945 for MPV, and p < 0.001, OR = 0.803; CI 0.735-0.878 for sodium. Conclusion: NLR, low MPV, and hyponatremia have a role in the diagnosis of complicated appendicitis, and they can be predictors of complicated appendicitis.