EVALUATING THE ACCURACY OF THE NEUTROPHIL-TO-LYMPHOCYTE RATIO IN DIAGNOSING ACUTE APPENDICITIS

Authors

  • Muhammad Adnan Rashid Department of Community Medicine, Ayub Medical College, Abbottabad-Pakistan
  • Hamza Javed Department of Surgery, Ayub Medical College Abbottabad-Pakistan
  • Fida Muhammad Department of Surgery, Ayub Medical College Abbottabad-Pakistan
  • Fatima Asad Department of Surgery, Ayub Medical College Abbottabad-Pakistan
  • Dania Dawood Department of Surgery, Ayub Medical College Abbottabad-Pakistan
  • Easha Jadoon Department of Surgery, Ayub Medical College Abbottabad-Pakistan
  • Gulalay Shamal Department of Surgery, Ayub Medical College Abbottabad-Pakistan
  • Amir Moavia Department of Surgery, Ayub Medical College Abbottabad-Pakistan

DOI:

https://doi.org/10.55519/JAMC-04-10763

Keywords:

Neutrophils to lymphocytes ratio, NLR, Acute Appendicitis, Alvarado score, Validity parameters

Abstract

Background: Acute Appendicitis, a surgical emergency, is one of the most common causes of acute abdomen. Its’ immediate diagnosis and surgery are of immense significance for the disease itself and its surgery carries a potential risk of morbidity and mortality. The goal of this study was to find out the role of Neutrophils to Lymphocyte Ratio (NLR) in making a confident diagnosis of acute appendicitis in a facility limited setup. Methods: It is a cross-sectional validation study on 100 patients admitted to the surgical wards of Ayub Teaching Hospital Abbottabad, with suspicion of Acute Appendicitis (AA), who subsequently underwent open appendectomy. Data were collected regarding the demography (name, age, gender) of the patient, physical examination, clinical presentations, and investigations including the complete blood count, from which the NLR value was calculated. Data was also collected regarding the histopathology examination of the appendix. Results: The sensitivity was 70.65% while the specificity was 87.5% and accuracy was 72%. Positive Predictive Value (PPV) was 98.4% and NPV was 20.6%. Conclusion: There is a strong correlation between NLR value and Acute Appendicitis. According to the results of our study, NLR ≥ 2.5 seems to be a reliable parameter to obtain a more certain diagnosis of Acute Appendicitis.

Author Biography

Muhammad Adnan Rashid, Department of Community Medicine, Ayub Medical College, Abbottabad-Pakistan

Associate professor, Department of community medicine, Ayub medical college, Abbottabad

References

: Toktas O, Aslan M. Mean platelet volume, red cell distribution width, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in the diagnosis of acute appendicitis. Eastern Journal Of Medicine. 2017;22(1):5.

: Snyder MJ, Guthrie M, Cagle SD. Acute appendicitis: efficient diagnosis and management. American family physician. 2018;98(1):25-33.

: Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, Boermeester M, Sartelli M, Coccolini F, Tarasconi A, de'Angelis N. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World journal of emergency surgery. 2020;15(1):1-42.

: Tanrıkulu CŞ, Karamercan MA, Tanrıkulu Y, Öztürk M, Yüzbaşıoğlu Y, Coşkun F. The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis. Turkish Journal of Surgery/Ulusal cerrahi dergisi. 2016;32(2):115.

: Faraj FH, Karim SA, Fattah FH. Role of neutrophil/lymphocyte ratio in diagnosis of acute appendicitis. JSMC. 2015;5(2):85-93.

: Shuaib A, Shuaib A, Fakhra Z, Marafi B, Alsharaf K, Behbehani A. Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis. World journal of emergency medicine. 2017;8(4):276.

: Matthew Fields J, Davis J, Alsup C, Bates A, Au A, Adhikari S, Farrell I. Accuracy of point-of-care ultrasonography for diagnosing acute appendicitis: a systematic review and meta-analysis. Academic Emergency Medicine. 2017;24(9):1124-36.

: Rud B, Vejborg TS, Rappeport ED, Reitsma JB, Wille-Jørgensen P. Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database of Systematic Reviews. 2019(11).

Gross I, Siedner-Weintraub Y, Stibbe S, Rekhtman D, Weiss D, Simanovsky N, Arbell D, Hashavya S. Characteristics of mesenteric lymphadenitis in comparison with those of acute appendicitis in children. European journal of pediatrics. 2017;176(2):199-205.

: Yazar FM, Bakacak M, Emre A, Urfalıoglu A, Serin S, Ceng iz E, Bülbüloglu E. Predictive role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosis of acute appendicitis during pregnancy. The Kaohsiung journal of medical sciences. 2015;31(11):591-6.

: Liu W, Wei Qiang J, Xun Sun R. Comparison of multislice computed tomography and clinical scores for diagnosing acute appendicitis. Journal of International Medical Research. 2015;43(3):341-9.

: Maghsoudi LH, Kabir K, Soltanian A, Pak H, Ahmadinejad M, Ahmadi AK. A cross-sectional study on evaluation of complete blood count-associated parameters for the diagnosis of acute appendicitis. Health Science Reports. 2021;4(3):e326.

: Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. International Journal of Surgery. 2018;56:307-14.

: Kucuk E. The change of neutrophil lymphocyte ratio in acute appendicitis. Medicine Science. 2015;4(3):2379-87.

: Baird DL, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. Bmj. 2017;357.

: Almaramhy HH. Acute appendicitis in young children less than 5 years. Italian journal of pediatrics. 2017;43(1):15.

: Rabindra KC, Lohani I. Comparison of the use of neutrophil: lymphocyte count ratio (NLCR) to total leukocyte count in diagnosing appendicitis in adults. Journal of Society of Surgeons of Nepal. 2018;21(2):24-7.

: Pereira C, Martis M, D'Souza R, Tauro LF. Can neutrophil-to-lymphocyte ratio be used as a predictor in acute appendicitis?. Journal of Emergency Medicine, Trauma and Acute Care. 2021;2021(1):6.

: Elston DM. The Hawthorne effect. Journal of the American Academy of Dermatology. 2021.

: Tuncer AA, Cavus S, Balcioglu A, Silay S, Demiralp I, Calkan E, Altin MA, Eryilmaz E, Karaisaoglu AO, Bukulmez A, Dogan I. Can mean platelet volume, Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, Platelet-to-Lymphocyte ratios be favourable predictors for the differential diagnosis of appendicitis. JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION. 2019;69(5):647-53.

: Khan A, Riaz M, Kelly ME, Khan W, Waldron R, Barry K, Khan IZ. Prospective validation of neutrophil-to-lymphocyte ratio as a diagnostic and management adjunct in acute appendicitis. Irish Journal of Medical Science (1971-). 2018;187(2):379-84.

: Kostakis ID, Machairas N, Damaskos C, Doula C, Tsaparas P, Charalampoudis P, et al, Platelet indices and neutrophil to lymphocyte ratio in adults with acute appendicitis. South African Journal of Surgery. 2016;54(1):29-34.

: Ahmed S, Jha A, Ali FM, Ghareeb AE, Garg D, Jha M. Sensitivity and Specificity of the Neutrophil-lymphocyte Ratio in the Diagnosis of Acute Appendicitis. Annals of Clinical & Laboratory Science. 2019;49(5):632-8.

: Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. The American Journal of Surgery. 2020;219(1):154-63.

Published

2024-11-25

How to Cite

Muhammad Adnan Rashid, Javed, H., Fida Muhammad, Fatima Asad, Dania Dawood, Easha Jadoon, … Amir Moavia. (2024). EVALUATING THE ACCURACY OF THE NEUTROPHIL-TO-LYMPHOCYTE RATIO IN DIAGNOSING ACUTE APPENDICITIS. Journal of Ayub Medical College Abbottabad, 36(4). https://doi.org/10.55519/JAMC-04-10763