Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department

BACKGROUND: The objective of this research was to evaluate the potential clinical utility of baseline hematological parameters measured on admission as adjuncts in the identification of complicated and uncomplicated appendicitis in children.
METHODS: The records of a total of 334 pediatric patients who underwent curative surgery for acute appendicitis (AA) between 2015 and 2016 were retrospectively investigated. The patients were categorized as complicated or uncomplicated appendicitis based on the histopathological reports. The clinical features and baseline hematological parameters of leukocyte count, neutrophil percentage, thrombocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW), and platelet distribution width (PDW) of the groups were compared.
RESULTS: Complicated AA was determined in 36 (10.8%) patients. The white blood cell count (WBC) (p<.001), neutrophil percentage (p<.001), NLR (p<.001), and PLR (p=.004) were higher in the complicated appendicitis group compared with the uncomplicated group, while the RDW, MPV, and PDW levels were uninformative. Analysis of receiver operating characteristic curves yielded the cut­off values of 14.870 cell/mm3 for WBC (area under the curve [AUC]: 0.675; sensitivity: 86.1%; specificity: 41.6%), 10.4 for NLR (AUC: 0.717; sensitivity: 61.1%; specificity: 73.2%), and 284 for PLR (AUC: 0.647; sensitivity: 42%; specificity: 86%) were found to be the best predictive values for the determination of complicated acute appendicitis.
CONCLUSION: The present study demonstrated that AA patients with higher NLR and PLR levels might be more likely to develop a complication. The NLR and PLR values combined with a physical examination, imaging studies, and other laboratory tests may help clinicians to identify high-risk AA patients in the emergency department.

Pediatrik acil serviste komplike apandisitin belirlenmesinde nötrofil-lenfosit oraný ve trombosit-lenfosit oranýnýn rolü

AMAÇ: Çocuklarda komplike ve komplike olmayan apandisitin saptanmasýnda yardýmcý olarak baþlangýç hematolojik parametrelerin olasý klinik faydalarýný deðerlendirmek amaçlandý.
GEREÇ VE YÖNTEM: 2015’ten 2016’ya kadar akut apandisit için küratif cerrahi geçiren 334 pediatrik hasta geriye dönük olarak incelendi. Hastalar histopatolojik raporlara dayanarak komplike veya komplike olmayan apandisit olarak sýnýflandýrýldý. Klinik bulgular ve temel hematolojik parametrelerden lökosit sayýsý, nötrofil yüzdesi, trombosit sayýsý, nötrofil-lenfosit oraný (NLR), trombosit-lenfosit oraný (PLR), ortalama trombosit hacmi, kýrmýzý hücre daðýlým geniþliði, trombosit daðýlým geniþliði gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Komplike akut apandisit 36 (%10.8) hastada bulundu. Komplike apandisitte WBC (p<0.001), nötrofil yüzdesi (p<0.001), NLR (p<0.001), PLR (p=.004) komplike olmayan gruba göre daha yüksek iken, RDW, MPV, PDW düzeyleri anlamlý fark bulunmadý. ROC eðrilerinin analizi, WBC için 14.870 hücre/mm3 (eðri altýndaki alan [AUC], 0.675; duyarlýlýk, %86.1; özgüllük, %41.6), NLR için 10.4 (AUC, 0.717; duyarlýlýk, %61.1, özgüllük, %73.2), PLR için 284 (AUC, 0.647; duyarlýlýk, %42; özgüllük, %86) komplike akut apandisitin belirlenmesinde en iyi kestirim deðerler olarak bulundu.
TARTIÞMA: Bu çalýþma, daha yüksek NLR ve PLR düzeylerine sahip akut apandisitli hastalarda komplikasyon geliþme olasýlýðýnýn daha yüksek olabileceðini göstermiþtir. Klinisyenlerin acil servisteki yüksek riskli akut apandisit hastalarýný tespit etmelerine yardýmcý olmak için fizik muayene, görüntüleme çalýþmalarý ve diðer laboratuvar testleri ile birlikte NLR ve PLR kullanýlmasýný öneririz.