Publication:

Neutrophil-lymphocyte ratio as a severity predictor in acute appendicitis

Background Acute appendicitis is a frequent surgical admission that requires timely diagnosis and swift treatment. While the gold-standard diagnostic modality is CT scan, some healthcare settings cannot offer imaging to all patients. Resource-limited hospitals have to make a diagnosis of acute appendicitis on a combination of physical exam and laboratory results. The neutrophil-to-lymphocyte ratio (NLR) is a simple and cost-effective marker of subclinical inflammation, easily calculated from white blood cell differential counts.

Methods A retrospective analysis was conducted on medical records of patients diagnosed with acute appendicitis between 2021 and 2022 at a Tertiary Referral Center in Mexico. Leukocyte and lymphocyte counts were studied to establish the NLR and its association with the severity and stage of appendicitis with post-surgical pathology outcomes.

Results The 362 patients were included for analysis. NLR was greater in patients with complicated acute appendicitis (p<0.001). Specificity and sensitivity for diagnosis of any severity of disease were 78% and 53% while for prediction of complicated cases was 81% in sensitivity and specificity of 48%.

Conclusions The present study demonstrated that the NLR is a valuable marker for diagnosing acute appendicitis and predicting its severity. A simple complete blood count provides a cost-effective option for vulnerable populations and healthcare systems.