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Neutrophil-to-lymphocyte ratio as an adjunct to clinical scoring systems for diagnosing perforated appendicitis in
Ahmad Saadat1,2, Sara Saadat3, Mostafa Abrishami2
1Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
The neutrophil-to-lymphocyte ratio (NLR) is a highly effective diagnostic tool for perforated appendicitis in children, outperforming other markers. Combining NLR with scoring systems like the appendicitis inflammatory response (AIR) score can improve diagnostic accuracy.
Area of Science:
- Pediatric Surgery
- Diagnostic Accuracy
- Inflammatory Markers
Background:
- Accurate diagnosis of appendicitis in children is crucial for timely treatment and preventing complications.
- Perforated appendicitis requires prompt intervention to minimize adverse outcomes.
Purpose of the Study:
- To evaluate the diagnostic efficacy of laboratory tests and clinical scoring systems in identifying pediatric patients with perforated appendicitis.
- To compare the sensitivity, specificity, and predictive accuracy of various markers in differentiating perforated from non-perforated appendicitis.
Main Methods:
- Prospective cohort study of 200 pediatric patients undergoing surgery for suspected appendicitis (2021-2023).
- Assessment of laboratory markers, Alvarado score (AS), Pediatric Appendicitis Score (PAS), and Appendicitis Inflammatory Response (AIR) score.
- Analysis of sensitivity, specificity, and Area Under the Curve (AUC) for each diagnostic tool.
Main Results:
- Neutrophil-to-lymphocyte ratio (NLR) demonstrated superior diagnostic performance (AUC=0.987) compared to white blood cell count and C-reactive protein.
- The AIR score showed strong performance (AUC=0.833) in children under 4 years old.
- AS (AUC=0.648) and PAS (AUC=0.688) exhibited limited accuracy in diagnosing perforated appendicitis.
Conclusions:
- The Alvarado score and Pediatric Appendicitis Score have limited discriminative power for perforated appendicitis in children.
- The Appendicitis Inflammatory Response score is more effective, especially in younger children.
- Neutrophil-to-lymphocyte ratio shows the highest diagnostic performance and can enhance accuracy when used with other scoring systems.
Background:
Prompt identification of children susceptible to appendicitis is essential to ensure optimal therapeutic intervention and minimize adverse sequelae. This study assesses the efficacy of laboratory tests and clinical examination findings in diagnosing pediatric patients with perforated appendicitis.
Methods:
This prospective cohort study included children susceptible to appendicitis who had surgery from 2021 to 2023. Laboratory markers, the Alvarado score (AS), the pediatric appendicitis score (PAS), and the appendicitis inflammatory response (AIR) score were assessed for sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to differentiate between perforated and non-perforated appendicitis.
Results:
A total of 200 patients (174 with non-perforated conditions and 26 with perforated conditions) were evaluated, revealing statistically significant differences in AS between the groups (P = 0.044). Neutrophil-to-lymphocyte ratio (NLR) surpassed the white blood cell (AUC = 0.644) and the C-reactive protein (AUC = 0.632), exhibiting remarkable predictive capability (AUC = 0.987; sensitivity = 100%; specificity = 95.4%). AIR had strong performance (AUC = 0.833) in children under 4 years old, but AS (AUC = 0.648) and PAS (AUC = 0.688) displayed inadequate predictive accuracy.
Conclusion:
The AS and PAS demonstrated limited discriminative power, whereas the AIR score performed more favorably, particularly in children under 4 years of age. The NLR showed the strongest diagnostic performance and, when applied alongside established scoring systems, may enhance accuracy in differentiating perforated from nonperforated appendicitis in pediatric patients.
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