Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Differentiating Appendicitis Severity: A...

Acute appendicitis is a frequent cause of abdominal pain, and accurate distinction between simple and complex forms is crucial for guiding treatment. Traditional diagnostic approaches, such as imaging and clinical scoring systems, often provide suboptimal accuracy. Recently, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have drawn attention as convenient, inexpensive indicators of systemic inflammation. However, their reported diagnostic value varies across studies. This study aimed to assess the effectiveness of NLR and PLR in differentiating simple from complex appendicitis, with additional analysis by age group to improve clinical relevance.

We searched for relevant studies published before May 2025. We assessed the diagnostic accuracy of NLR and PLR for complex appendicitis using receiver operating characteristic (ROC) curve analysis and forest plots.

A total of 60 studies (54 evaluating NLR, 23 assessing PLR) were included. The pooled area under the curve (AUC) of NLR for diagnosis was 0.76 in the overall population. Age-stratified analysis showed that NLR achieved a sensitivity of 0.72, specificity of 0.64, and AUC of 0.74 in pediatric patients, while in adults, sensitivity was 0.70, specificity was 0.67, and AUC was 0.74. For PLR, pooled sensitivity and specificity were 0.58 and 0.69, respectively (AUC = 0.67).

NLR is a more reliable biomarker than PLR for identifying complex appendicitis, aiding early clinical decision-making.