DIAGNOSING CASES OF COMPLICATED APPENDICITIS USING NEUTROPHIL-LYMPHOCYTE RATIO: A PROSPECTIVE STUDY

Authors

  • SN SHAIKH Department of General Surgery, Dow University of Health Sciences (DUHS), Civil Hospital Karachi (CHK), Karachi, Pakistan
  • F ZAHEER Department of General Surgery, Dow University of Health Sciences (DUHS), Civil Hospital Karachi (CHK), Karachi, Pakistan
  • H KHAN Department of General Surgery, Dow University of Health Sciences (DUHS), Civil Hospital Karachi (CHK), Karachi, Pakistan
  • N MAQBOOL Department of General Surgery, Dow University of Health Sciences (DUHS), Civil Hospital Karachi (CHK), Karachi, Pakistan
  • K SHEIKH Department of General Surgery, Dow University of Health Sciences (DUHS), Civil Hospital Karachi (CHK), Karachi, Pakistan
  • S SHAIKH Peoples University of Medical and Health Sciences (PUMHS), Nawabshah, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.555

Keywords:

Neutrophil-lymphocyte, ratio, appendicitis, NLR, complicated

Abstract

This study aimed to investigate the significance of the neutrophil-lymphocyte ratio (NLR) in the diagnosis of complicated appendicitis and distinguish it from uncomplicated appendicitis. Acute appendicitis is a typical surgical emergency, with a lifetime probability of 8.6% for males and 6.7% for females. It is crucial to diagnose and treat this condition promptly to prevent complications such as perforation, peritonitis, and fluid collection, which can lead to extended hospital stays, morbidity, and mortality. The prospective observational study lasted for three months at Ruth K.M. Pfau Civil Hospital, Karachi. Patients between the ages of 16 and 40 who were diagnosed with acute appendicitis using clinical and/or radiological evidence and underwent appendectomy were included in the study. Pre-operative assessments and laboratory results, including NLR, were recorded and compared to operative findings. The study found that NLR values greater than 8.0 were indicative of complicated appendicitis, with a sensitivity of 90.9% and a specificity of 100%. Therefore, NLR has a high predictive value for identifying complicated appendicitis in our local population.

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References

Ahmed, S., Jha, A., Ali, F. M., Ghareeb, A. E., Garg, D., and Jha, M. (2019). Sensitivity and Specificity of the Neutrophil-lymphocyte Ratio in the Diagnosis of Acute Appendicitis. Annals of Clinical & Laboratory Science 49, 632-638.

Akyüz, M., Topal, U., Gök, M., Öz, B., İsaoğulları, Ş. Y., and Sözüer, E. M. (2020). Predictive Value of Neutrophil/Lymphocyte Ratios in the Diagnosis of Acute Appendicitis. Medical journal of bakirkoy 16.

Alvarado, A. (2016). How to improve the clinical diagnosis of acute appendicitis in resource limited settings. World journal of emergency surgery 11, 1-4.

Ayeni, A., Mahmood, F., Mustafa, A., Mcleish, B., Kulkarni, V., Singhal, S., and Akingboye, A. (2022). Predicting the severity of acute appendicitis in children using neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Cureus 14.

Bălănescu, L., Băetu, A. E., Cardoneanu, A. M., Moga, A. A., and Bălănescu, R. N. (2022). Predictors of complicated appendicitis with evolution to appendicular peritonitis in pediatric patients. Medicina 59, 21.

Balogun, O. S., Osinowo, A., Afolayan, M., Olajide, T., Lawal, A., and Adesanya, A. (2019). Acute perforated appendicitis in adults: Management and complications in Lagos, Nigeria. Annals of African medicine 18, 36.

Behairy, G. M., Elghandour, A. M., and Khaled, I. (2019). The Validity of Modified Alvarado Scoring System as a Predictor Tool for Diagnosis of Acute Appendicitis in a Low-income Country; a Comparative Prospective Study. Suez Canal University Medical Journal 22, 170-178.

Berridge, M. (2014). Cell stress, inflammatory responses and cell death. Cell signalling biology 2014, 1-30.

Boshnak, N., Boshnaq, M., and Elgohary, H. (2018). Evaluation of platelet indices and red cell distribution width as new biomarkers for the diagnosis of acute appendicitis. Journal of Investigative Surgery 31, 121-129.

Buonacera, A., Stancanelli, B., Colaci, M., and Malatino, L. (2022). Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. International journal of molecular sciences 23, 3636.

Calis, H. (2018). Morbidity and Mortality in Appendicitis in the Elderly. J Coll Physicians Surg Pak 28, 875-8.

Hajibandeh, S., Hajibandeh, S., Hobbs, N., and Mansour, M. (2020). 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 219, 154-163.

Iftikhar, M., Shah, S., Shah, I., Shah, J. A., and Faisal, M. (2021). Outcomes of conservative management of acute appendicitis during COVID-19 pandemic. Pain 51, 48-43.

Mekrugsakit, N., and Tullavardhana, T. (2023). The Value of Complete Blood Count Parameters in Pre-dicting Complicated Acute Appendicitis; a Prognostic Ac-curacy Study. Archives of Academic Emergency Medicine 11, e42.

Mukherjee, R., and Samanta, S. (2019). Surgical emergencies in pregnancy in the era of modern diagnostics and treatment. Taiwanese Journal of Obstetrics and Gynecology 58, 177-182.

Naik, B. B. (2021). A clinical study on conservative management of acute appendicitis in a tertiary care centre. International Surgery Journal 8, 1190-1194.

Oymaci, E., Kahramansoy, N., Tan, S., Aydogan, S., and Yildirim, M. (2023). The diagnostic role of pre-operativee blood tests in complicated appendicitis: A feasible approach to surgical decision. Nigerian Journal of Clinical Practice 26, 1005-1010.

Peksöz, R., Dişçi, E., Kaya, A., Ağırman, E., Korkut, E., Aksungur, N., Altundaş, N., Kara, S., and Atamanalp, S. S. (2022). Significance of laboratory parameters in diagnosing acute appendicitis during pregnancy. ANZ Journal of Surgery 92, 121-127.

Rajalingam, V. R., Mustafa, A., Ayeni, A., Mahmood, F., Shammout, S., Singhal, S., Akingboye, A., and Singhal, S. (2022). The role of neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) as a biomarker for distinguishing between complicated and uncomplicated appendicitis. Cureus 14.

Sengul, S., Guler, Y., Calis, H., and Karabulut, Z. (2020). The role of serum laboratory biomarkers for complicated and uncomplicated appendicitis in adolescents. J Coll Physicians Surg Pak 30, 420-424.

Sipra, M. A., Kothari, M., Almakki, A. A., Diakatou, E., Ahmed, D., Ansari, G. A., Alsaeed, M. M., and Alhayek, A. A. (2021). The predictive value of neutrophil-to-lymphocyte ratio to diagnose acute appendicitis and grade its severity. Journal of Pediatric and Adolescent Surgery 2, 19-23.

Ünal, Y. (2018). A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Turkish Journal of Trauma & Emergency Surgery/Ulusal Travma ve Acil Cerrahi Dergisi 24.

Yang, Z., Sun, F., Ai, S., Wang, J., Guan, W., and Liu, S. (2019). Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult. BMC surgery 19, 1-10.

Yılmaz, E. M., Kapçı, M., Çelik, S., Manoğlu, B., Avcil, M., and Karacan, E. (2017). Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation? Turkish Journal of Trauma and Emergency Surgery 23, 29-33.

Yokoyama, S., Takifuji, K., Hotta, T., Matsuda, K., Nasu, T., Nakamori, M., Hirabayashi, N., Kinoshita, H., and Yamaue, H. (2009). C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study. World Journal of Emergency Surgery 4, 1-5.

Zarog, M., O'Leary, P., Kiernan, M., Bolger, J., Tibbitts, P., Coffey, S., Byrnes, G., Peirce, C., Dunne, C., and Coffey, C. (2023). Circulating fibrocyte percentage and neutrophil-lymphocyte ratio are accurate biomarkers of uncomplicated and complicated appendicitis: a prospective cohort study. International Journal of Surgery 109, 343-351.

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Published

2023-12-15

How to Cite

SHAIKH, S., ZAHEER, F., KHAN, H., MAQBOOL, N., SHEIKH, K., & SHAIKH, S. (2023). DIAGNOSING CASES OF COMPLICATED APPENDICITIS USING NEUTROPHIL-LYMPHOCYTE RATIO: A PROSPECTIVE STUDY. Biological and Clinical Sciences Research Journal, 2023(1), 555. https://doi.org/10.54112/bcsrj.v2023i1.555