The Role of Neutrophil-to-Lymphocyte Ratio in the Diagnosis of Acute Appendicitis

Sundus A Khan; Raza Ashraf; Narmeen Hassaan; Mubashar Naseer; Muhammad Hassan Azad; Hamza Javed

doi:10.7759/cureus.51164

The Role of Neutrophil-to-Lymphocyte Ratio in the Diagnosis of Acute Appendicitis

Cureus. 2023 Dec 27;15(12):e51164. doi: 10.7759/cureus.51164. eCollection 2023 Dec.

Authors

Sundus A Khan¹, Raza Ashraf², Narmeen Hassaan², Mubashar Naseer², Muhammad Hassan Azad², Hamza Javed³

Affiliations

¹ General Surgery, Northwest School of Medicine, Peshawar, PAK.
² General Surgery, Shifa International Hospital, Islamabad, PAK.
³ Radiology, Ayub Teaching Hospital, Abbottabad, PAK.

Abstract

Background: Acute appendicitis (AA), a common reason for episodes of acute abdomen, is a surgical emergency. Its immediate diagnosis and management are of immense significance, as its diagnosis can become challenging at times, especially in resource-limited setups. The goal of this study was to ascertain the threshold value for the neutrophil-to-lymphocyte ratio (NLR) in diagnosing AA and to calculate the validity parameters for the NLR.

Methodology: A cross-sectional study was carried out involving 108 patients who were admitted to the surgical wards of Ayub Teaching Hospital, Abbottabad with suspicion of AA and subsequently underwent open appendectomy. Data was collected regarding the demography of the patients, physical examination findings, clinical presentations, and investigations including the histopathology and complete blood count, from which the NLR value was computed, and the Statistical Package for Social Sciences (SPSS), version 25.0 (IBM Corp., Armonk, NY) was utilized for the computation. Receiver operating characteristic (ROC) analysis was done to calculate the cut-off value of the NLR for diagnosing AA, and validity parameters were computed, taking into account statistical significance with a p-value < 0.05.

Results: Based on the ROC analysis, a threshold value for NLR indicating a positive appendectomy was determined to be 2.49 (sensitivity = 71.4% and 1-specificity = 12.5%) with an area under the curve of 90.6% (95% confidence interval {CI} 0.818-0.994, p<0.001). The sensitivity, specificity, and diagnostic accuracy of NLR for diagnosing AA were 71.43%, 87.5%, and 72.73%, respectively.

Conclusion: There is a strong correlation between NLR at a cut-off value of 2.49 and the diagnosis of AA. We suggest that NLR should be utilized as a complementary biomarker to clinical examination, aiding in the diagnosis of AA.

Keywords: acute appendicitis; alvarado score; hawthorn bias; neutrophils to lymphocytes ratio; receiver operating characteristic (roc) analysis; validity parameters.