Evaluation of the Sensitivity of Preoperative Neutrophile/Lymphocyte Ratio to Differentiate between Complicated and Non-Complicated Appendicitis
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- Category: Vol. 93, March 2025
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Evaluation of the Sensitivity of Preoperative Neutrophile/Lymphocyte Ratio to Differentiate between Complicated and Non-Complicated Appendicitis, MOHAMMED A. RAJAB ABURAS and EHTUISH F. EHTUISH
Abstract
Background: Preoperative prediction of the degree of diffi culty of acute appendicitis is a matter of challenge among sur geon. Several methods could determine the preoperative state of acute appendicitis including imaging ability of the hospital (ultrasonographic study and CT). However, there much easier biochemical parameters which includes CRP, WBC count, and NLR. Various study try to detect which of them is more eas ier, and give the most rapid accurate result about the degree of severity of acute appendicitis. This issue has importunacy in determining experience of the surgeon who will operate on, especially in rural area. NLR was found to be more sensitive, more accurate, and much easier than CRP and WBCs. It dose not need any extra cost. Aim of Study: To evaluate the usefulness of NLR in the di agnostic work-up of preoperative differentiation between non complicated acute appendicitis and complicated. Material and Methods: A retrospective review of the data base of 100 patients in Agouza Hospital between March 2017 and March 2020 who underwent surgery was evaluated. Based on intraoperative finding wither it was just acute appendicitis or complicated appendicitis, the patients were divided into two groups: Acute appendicitis and complicated appendicitis. Data extracted included patients’ demography, preoperative WCC with differential count, CRP. Receiver-operating characteristic (ROC) curve is used to calculate Sensitivity, specificity, pos itive predictive value and negative predictive value (NPV) of WCC, CRP and NLR and establishing cut-off value for each biomarker. Results: The study include 100 patient, male/female is 33/67, with 71 noncomplicated cases and 29 complicated. Main age of complicated cases 36.06±9.66, and that of noncompli- cated is 24.85±7.7. The ROC curve results found that when the cutoff value of NLR >4, the sensitivity was 100%, specificity 84.5% with area under the curve (AUC) 0.983 (p-value <0.001). as regard results of WBCs count, at cutoff value >12000, the sensitivity will be 68.97%, specificity was 94.37%, with AUC 0.835 (p-value <0.001). While ROC curve analysis of CRP re sults found that with cutoff value >22, the sensitivity was 40%, specificity was77%, AUC was 0.531 (p-value=0.645). Conclusion: The NLR was the most sensitive and accurate test for differentiation between uncomplicated acute appendici tis and complicated acute appendicitis,