Tunç EREN, Ercüment TOMBALAK, Buşra BURCU, İbrahim Ali ÖZEMİR, Metin LEBLEBİCİ, Sedat ZİYADE, Özgür EKİNCİ, Orhan ALİMOĞLU

Akut Apandisit Olgularında Nötrofil/Lenfosit Oranının Tanıda ve Hastalığın Şiddetini Belirlemedeki Prediktif Değeri

Amaç: Akut apandisit olgularında ameliyat öncesi rutin hemogram tetkikinde saptanan nötrofil/lenfosit oranının (NLO) tanı koymada ve gangrene/perfore apandisiti ön görmedeki etkisini incelemeyi amaçladık. Yöntemler: Ocak 2013 ile Eylül 2014 arasında apendektomi uygulanan 162 hastanın yaş, cinsiyet, c-reaktif protein (CRP), lökosit, nötrofil, lenfosit sayısı ve NLO ile ameliyat sonrası histopatolojik inceleme sonuçlarını içeren verileri retrospektif olarak incelendi ve istatistiksel olarak değerlendirildi. Bulgular: Çalışma grubundaki hastaların 97’si (%59,9) erkek ve 65’i (%40,1) kadındı. Ortalama yaş 36,01 (18-90) hesaplandı. Ameliyat sonrası patoloji sonuçlarına göre 21 (%12,96) hastada normal apendiks ve 141 (%87,04) hastada akut apandisit saptandı. 41 (%25,31) hastada ise gangrene/perfore apandisit varlığı gözlendi. Akut apandisit olgularında lenfosit sayısı anlamlı derecede düşük iken CRP düzeyleri, lökosit sayısı, nötrofil sayısı ve NLO’nun anlamlı düzeyde yüksek olduğu gözlendi (p< 0,05). NLO ≥4,0 olan olgularda akut apandisit tanısı olasılığının 16,9 kat daha yüksek olduğu saptandı [p< 0,01; Odds oranı (Odds ratio - OR):16,864; %95 Güvenlik aralığı (Confidence interval - CI): 4,696-60,568]. NLO ≥4,5 olan olgularda ise apendiseal gangren/perforasyon riskinin 3,2 kat daha yüksek olduğu saptandı [p<0,01; OR: 3,258; %95 CI: 1,468-7,228]. Sonuç: Nötrofil/lenfosit oranı (NLO); akut apandisit tanısı koymada ve gangrene/perfore apandisiti ön görmede fizik muayene ve diğer tanısal yöntemlere yardımcı ve kullanışlı bir değişken olarak kabul edilebilir.

Anahtar Kelimeler:

Nötrofil/lenfosit oranı, akut apandisit, apendiseal gangren/perforasyon

Predictive value of Neutrophil/Lymphocyte Ratio for the Diagnosis and Severity of Disease in Acute Appendicitis

Objective: Our aim was to investigate the value of neutrophil/lymphocyte ratio for the diagnosis of acute appendicitis, and for the prediction of gangrenous/perforated appendicitis. Methods: The medical records of 162 patients having undergone appendectomies between January 2013 and September 2014 including age, gender, preoperatively assessed C-reactive protein (CRP), white blood cell (WBC), neutrophil (NEU), lymphocyte, and neutrophil/lymphocyte ratio (NLR) values were retrospectively evaluated, compared with the postoperative histopathological findings, and statistically analyzed. Results: The study group consisted of 97 (59.9%) men, and 65 (40.1%) women with a median age of 36.01 (18-90). Histopathological examinations revealed normal appendix in 21 (12.96%), and acute appendicitis in 141 (87.04%) patients. Appendiceal gangrene/perforation rate was 25.31%. Lymphocyte counts were decreased, while CRP, WBC, NEU, and NLR values were increased in acute appendicitis (p<0.05). NLR ≥4.0 was associated with 16.9 times increased possibility of acute appendicitis [p<0.01, Odds ratio (OR):16.864, 95% Confidence interval (CI):4.696-60.568]. In cases with NLR≥4.5, it was detected that the risk of appendiceal gangrene/perforation was 3.2 times higher [p<0.01, OR:3.258, 95% CI: 1.468-7.228]. Conclusions: In addition to physical examination and other diagnostic methods, NLR can be considered as a useful auxiliary tool for the diagnosis of acute appendicitis, and for the prediction of gangrenous/perforated appendicitis.

Keywords:

Neutophil/lymphocyte ratio, acute appendicitis, apendiceal gangrene/perforation,

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1. Fitzmaurice GJ, McWilliams B, Hurreiz H, Epanomeritakis E. Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence. Can J Surg 2011;54:307-314.
2. Varadhan KK, Humes DJ, Neal KR, Lobo DN. Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg 2010;34:199-209.
3. Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg 2012;97:299- 304.
4. Goodman DA, Goodman CB, Monk JS. Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis. Am Surg 1995;61:257-259.
5. Socea B, Carâp A, Rac-Albu M, Constantin V. The value of serum bilirubin level and of white blood cell count as severity markers for acute appendicitis. Chirurgia (Bucur) 2013;108:829-834.
6. Humes DJ, Simpson J. Acute appendicitis. BMJ 2006;333:530-534.
7. Lee JH, Park YS, Choi JS. The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol 2010;20:97-105.
8. Buckius MT, McGrath B, Monk J, et al. Changing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res 2012;175:185-190.
9. Fike FB, Mortellaro VE, Juang D, et al. The impact of postoperative abscess formation in perforated appendicitis. J Surg Res 2011;170:24-26.
10. Noh H, Chang SJ, Han A. The diagnostic values of preoperative laboratory markers in children with complicated appendicitis. J Korean Surg Soc 2012;83:237-241.
11. Jaffe BM, Berger DH. The Appendix. In: Brunicardi FC (ed). Schwartz’s principles of surgery. 9th ed, New York: McGrawHill, 2010:1073-1089.
12. Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med 2014;15:859-871.
13. Saaiq M, Niaz-Ud-Din, Jalil A, et al. Diagnostic accuracy of leukocytosis in prediction of acute appendicitis. J Coll Physicians Surg Pak 2014;24:67-69.
14. Goulart RN, Silvério G de S, Moreira MB, Franzon O. Main findings in laboratory tests diagnosis of acute appendicitis: a prospective evaluation. Arq Bras Cir Dig 2012;25:88-90.
15. Xharra S, Gashi-Luci L, Xharra K, et al. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis. World J Emerg Surg 2012;7:27.
16. Schellekens DH, Hulsewé KW, van Acker BA, et al. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis in patients suspected for acute appendicitis. Acad Emerg Med 2013;20:703-710.
17. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004;91:28-37.
18. Paajanen H, Mansikka A, Laato M, et al. Novel serum inflammatory markers in acute appendicitis. Scand J Clin Lab Invest 2002;62:579-584.
19. Wu HP, Lin CY, Chang CF, et al. Predictive value of C-reactive protein at different cutoff levels in acute appendicitis. Am J Emerg Med 2005;23:449-453.
20. Al-Abed YA, Alobaid N, Myint F. Diagnostic markers in acute appendicitis. Am J Surg 2015;209:1043-1047.
21. Panagiotopoulou IG, Parashar D, Lin R, et al. The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. Ann R Coll Surg Engl 2013;95:215-221.
23. Kamran H, Naveed D, Nazir A, et al. Role of total leukocyte count in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2008;20:70-71.
24. Yazici M, Ozkisacik S, Oztan MO, Gürsoy H. Neutrophil/ lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010;52:400-403.
25. Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg 2010;110:543-547.
26. Białas M, Taran K, Gryszkiewicz M, Modzelewski B. Evaluation of neutrophil-lymphocyte ratio usefulness in the diagnosis of appendicitis. Wiad Lek 2006;59:601-606.
27. Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today 2016;46:84- 89.