Egemen KÜÇÜK

The Change of Neutrophil Lymphocyte Ratio in Acute Appendicitis

Acute appendicitis is the most common indication for emergency abdominal surgery, although it remains difficult to diagnose. Aim of this study is to investigate the supporting role of neutrophil/lymphocyte ratio in diagnosis of acute appendicitis. The medical records of 241 patients who had undergone appendectomy between June 2013 and March 2014 were investigated retrospectively. Sixty patients who had undergone at least one complete blood count during preoperative hospital admission and who had no other active inflammatory conditions at the time the sample was taken were included in the study. Neutrophil/lymphocyte ratio and leukocyte count values were determined in each patient at hospital admission and during active acute appendicitis. Age, sex, neutrophil/lymphocyte ratio and leukocyte counts were recorded for each patient. The mean age of the patients was 33.15±10.94 years; male to female ratio was 1.5:1. Mean leukocyte count was significantly higher in acute appendicitis group (13.14±2.99×103/mm3) than control group (7.42±2.12×103/mm3) (p=0.01). The best cutoff point for leukocyte count was 10.10×103/mm3, neutrophil/lymphocyte ratio was significantly higher in acute appendicitis group (5.47±3.24) than control group (1.99±1.11) (p=0.02). The best cutoff point for neutrophil/lymphocyte ratio was 1.73, with sensitivity of 97% and a specificity of 87%. Area under receiver operating characteristic curve was 0.67 for leukocyte count and 0.60 for neutrophil/lymphocyte ratio. Neutrophil/lymphocyte ratio was significantly higher in acute appendicitis and can be used as a supportive diagnostic parameter in the diagnosis of acute appendicitis

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1. Gaitini D, Beck-Razi N, Mor-Yosef D, Fischer D, Ben Itzhak O, Krausz MM, Engel A. Diagnosing Acute Appendicitis in Adults: Accuracy of Color Doppler Sonography and MDCT Compared with Surgery and Clinical Follow-Up. AJR Am J Roentgenol. 2008;190(5):1300-6.

2. Itskowitz MS, Jones SM. Appendicitis. Emerg Med. 2004;36(10):10-5.

3. Mason RJ. Surgery for appendicitis: is it necessary? Surg Infect. 2008;9(4):481-8.

4. Graffeo CS, Counselman FL. Appendicitis. Emerg Med Clin North Am 1996;14(4):653-71.

5. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91(1):28-37.

6. Mehta J, Dinerman J, Mehta P, Saldeen TG, Lawson D, Donnelly WH, Wallin R. Neutrophil function in ischemic heart disease. Circulation. 1989;79(3):549-56.

7. Berridge MJ. Cell Stress, Inflammatory Responses and Cell Death. BJ Signal. 2012;Module 11:1-29.

8. de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14(5):R192.

9. Ahsen A, Ulu MS, Yuksel S, Demir K, Uysal M, Erdogan M, Acarturk G. As a new inflammatory marker for Familial Mediterranean Fever: neutrophil-to-lymphocyte ratio. Inflammation. 2013;36(6):1357-62.

10. Günay E, Sarınç Ulaşlı S, Akar O, Ahsen A, Günay S, Koyuncu T, Unlü M. Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study. Inflammation 2014;37(2):374-80.

11. Gokmen F, Akbal A, Resorlu H, Gokmen E, Guven M, Aras AB, Erbag G, Komurcu E, Akbal A, Cosar M. Neutrophil-Lymphocyte Ratio Connected to Treatment Options and Inflammation Markers of Ankylosing Spondylitis. J Clin Lab Anal. Accepted article: June 9, 2013. Published Online: May 21, 2014.

12. Whitney AR, Diehn M, Popper SJ, Alizadeh AA, Boldrick JC, Relman DA, Brown PO. Individuality and variation in gene expression patterns in human blood. Proct Natl Acad Sci USA. 2003;100(4):1896-901.

13. Gordon A, Greenfield EM, Eastell R, Kiss-Toth E, Wilkinson JM. Individual susceptibility to periprosthetic osteolysis is associated with altered patterns of innate immune gene expression in response to pro-inflammatory stimuli. J Orthop Res. 2010;28(9):1127-35.

14. Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010;89(3):219-29.

15. Mor G, Cardenas I, Abrahams V, Guller S. Inflammation and pregnancy: the role of the immune system at the implantation site. Ann N Y Acad Sci. 2011;1221(1):80-7.

16. Birchley D. Patients with clinical acute appendicitis should have pre-operative full blood count and C-reactive protein assays. Ann R Coll Surg Engl. 2006;88(1):27-32.

17. Albayrak Y, Albayrak A, Albayrak F, Yildirim R, Uylu B, Uyanik A, Kabalar E, Guzel IC. Mean platelet volume: a new predictor in confirming acute appendicitis diagnosis. Clin Appl Thromb Hemost. 2011;17(4):362-6.

18. Kahramanca S, Ozgehan G, Seker D, Gokce EI, Seker G, Tunc G, Kucukpinar T, Kargici H. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20(1):19-22.

19. 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(4):299-304.

20. 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(5):543-7.

21. Yazici M, Ozkisacik S, Oztan MO, Gursoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr. 2010;52(4):400-3.

22. Goodman DA, Goodman CB, Monk JS. Use of the neutrophil: lymphocyte ratio in the diagnosis of appendicitis. Am Surg. 1995;61(3):257-9.

23. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.