Diagnostic potential of neutrophil-to-lymphocyte ratio in pediatric acute appendicitis: A multi-centric study

Warda Tahir; Muhammad Usama Aziz; Rigman Darius Gabriel; Carlo Sturz; Arun Quadros Darian; Luisa Alejandra Morales Argueta

doi:10.5281/zenodo.8400443

Authors

Warda Tahir Department of Pediatric Surgery University of Child Health Sciences, The Children Hospital Lahore, Pakistan https://orcid.org/0000-0002-3420-2036
Muhammad Usama Aziz Department of Pediatric Surgery University of Child Health Sciences, The Children Hospital Lahore, Pakistan https://orcid.org/0000-0001-6445-4704
Rigman Darius Gabriel George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania https://orcid.org/0000-0001-5278-2946
Carlo Sturz Albert Ludiwgs Universität Freiburg, Faculty of Medicine, Freiburg, Germany https://orcid.org/0009-0009-0683-0770
Arun Quadros Darian Universidade de São Caetano do Sul, Brazil https://orcid.org/0000-0002-1842-6240
Luisa Alejandra Morales Argueta Department of Pediatrics, Nombre Clínica Morales Argueta, Guatemala https://orcid.org/0009-0002-1909-998X

DOI:

https://doi.org/10.5281/zenodo.8400443

Keywords:

Appendicitis, Children, Neutrophil-to-lymphocyte ratio

Abstract

Objective: In this study, we aimed to investigate the diagnostic value of NLR in pediatric appendicitis.

Materials and methods: This retrospective cohort study was undertaken in the pediatric emergency department of our hospital from January 2019 to December 2022. We enrolled patients aged between 5 and 18 years presenting with suspicions of acute appendicitis. Based on their final diagnoses, these patients were divided into two primary groups: Negative appendectomy (Group 1) and positive appendectomy (Group 2).

Results: In a comparative study of 290 pediatric patients divided into Group 1 (n=40) and Group 2 (n=250), we explored differences in demographics, presenting symptoms, and blood test results. Both groups had a similar age range (2-18 years) and gender distribution (p>0.05 for both age and gender). Abdominal pain, nausea, and vomiting were prevalent symptoms in both groups; however, statistical analysis revealed no significant differences in their presentation (p>0.05 for all symptoms). The duration of symptoms and past medical histories were also comparable between the groups (p>0.05). Blood test results indicated that Group 2 had significantly higher WBC (p=0.005) and neutrophil counts (p=0.003), while other parameters like CRP, platelet count, and lymphocyte count showed no significant differences (p>0.05 for all). The NLR was identified as a significant discriminator, with Group 2 having a higher value (p=0.002). Using an optimal NLR cut-off of 4.1, we achieved a sensitivity of 77% and a specificity of 52% for predicting the diagnosis. The diagnostic utility of NLR was further affirmed by an AUC value of 0.642 in the ROC curve analysis.

Conclusions: This study underscores the potential diagnostic value of the NLR in pediatric acute appendicitis. With its cost-effectiveness and easy availability as part of routine blood tests, the NLR could be an invaluable tool in assisting clinical decisions in pediatric acute appendicitis.

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