[Evaluation of neutrophil-lymphocyte ratio usefulness in the diagnosis of appendicitis]

The aim of the study was the evaluation ofneutrophil-lymphocyte ratio usefulness in the diagnosis of appendicitis.

The study concerned 469 patients: 280 (59.7%) women and 189 (40.3%) men (mean age 34 + 18 years), who underwent operation due to suspicion of appendicitis, in the years 1997-2003. Retrospective analysis ofintraoperative diagnoses, pathological reports and laboratory tests was performed. Optimal values ofneutrophil-lymphocyte (N/L) ratio and leukocytosis, according to sensitivity and specificity in appendicitis diagnosis, were chosen and then compared among patients with different stages of appendicitis. The results were evaluated according to their statistical significance.

Optimal values of N/L ratio and leukocytosis, according to sensitivity and specificity, were > or = 3.5 for N/L and > or = 12000/mm3 for leukocytosis. N/L ratio > or = 3.5 occurred to have much higher sensitivity (77.5% vs. 55%) but lower specificity (73.3% vs. 81.6%) than leukocytosis. Both leukocytosis and N/L had satisfactory values of prediction and likelihood ratio for positive ad negative results.

(1) N/L ratio has higher sensitivity than leukocytosis, especially in appendicitis phlegmonosa and gangrenosa. (2) Both leukocytosis and N/L ratio have quite high specificity. In cases other than appendicitis that have similar clinical symptoms and are ultimately diagnosed intraoperatively, the N/L ratio and leukocyte count are rarely elevated above 3.5 and 12000/mm3 respectively. (3) Due to easiness of calculation and still high rate of false positive and negative diagnoses, N/L ratio is worth using in establishing the diagnosis of appendicitis.