The predictive value of neutrophil-to-lymphocyte ratio in the diagnosis of children complicated appendicitis_Chinese Journal of Evidence-Based Medicine

Authors：

YU Qiang ¹ , GUO Zhengtuan ¹ , HE Yingli ² ,  WANG Jing ³

1. Department of Pediatric Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, P.R.China;
2. Department of Infectious Diseases, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, P.R.China;
3. Department of Rheumatology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, P.R.China;

Corresponding author：

WANG Jing, Email: kidip@163.com

Keywords：

Acute appendicitis; Neutrophil-to-lymphocyte ratio; Children; Diagnosis; Operation

DOI：

10.7507/1672-2531.201804113

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ObjectivesTo assess the predictive value of neutrophils-to-lymphocytes ratio (NLR) in the diagnosis of children complicated appendicitis.MethodsThe clinical data of patients with acute appendicitis treated in Department of Pediatric Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University from January 2014 to June 2017 were analyzed retrospectively. Based on the pathology results, patients were divided into two groups: simple appendicitis and complicated appendicitis. The differences of age, gender, disease time, fever, highest temperature, emesis, right lower abdominal pain, blood indicators, and ultrasound results between the two groups were analyzed. Useful parameters to aid in the diagnosis of children complicated appendicitis were screened through single-factor and multiple-factor analysis. The predictive value of the parameters was evaluated by ROC analysis, sensitivity and specificity.ResultsA total of 235 patients was evaluated and divided into simple appendicitis group (179 patients) and complicated appendicitis group (56 patients). Logistic regression analysis revealed that NLR was the independent risk factor for diagnosis of children complicated appendicitis. When NLR>11.74, the Youden index for predictive complicated appendicitis was the biggest, reaching 0.325, and the sensitivity and specificity were 47.8% and 84.7%, respectively (OR=3.121, 95%CI 2.036 to 4.783).ConclusionsThe preoperative NLR is a certain indicator for predicting children complicated appendicitis, and can be used as reference to whether or not receive an operation.

Citation： YU Qiang, GUO Zhengtuan, HE Yingli, WANG Jing. The predictive value of neutrophil-to-lymphocyte ratio in the diagnosis of children complicated appendicitis. Chinese Journal of Evidence-Based Medicine, 2018, 18(10): 1027-1031. doi: 10.7507/1672-2531.201804113 Copy

1.	Addiss DG, Shaffer N, Fowler BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol, 1990, 132(5): 910-925.
2.	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(2): 185-190.
3.	Collaborative S, Cuschieri J, Florence M, et al. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg, 2008, 248(4): 557-563.
4.	Ali N, Aliyu S. Appendicitis and its surgical management experience at the University of Maiduguri Teaching Hospital Nigeria. Niger J Med, 2012, 21(2): 223-226.
5.	Bhangu A, Soreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet, 2015, 386(10000): 1278-1287.
6.	Minneci PC, Mahida JB, Lodwick DL, et al. Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis. JAMA Surg, 2016, 151(5): 408-415.
7.	祝孟川, 曾永娟, 刘登瑞, 等. 阑尾切除术与抗生素比较治疗急性单纯性阑尾炎疗效和安全性的Meta分析. 中国循证医学杂志, 2017, 17(2): 188-194.
8.	Yu CW, Juan LI, Wu MH, et al. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg, 2013, 100(3): 322-329.
9.	Galizia G, Lieto E, Zamboli A, et al. Neutrophil to lymphocyte ratio is a strong predictor of tumor recurrence in early colon cancers: A propensity score-matched analysis. Surgery, 2015, 158(1): 112-120.
10.	Qi X, Li J, Deng H, et al. Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma: A systematic review and meta-analysis of observational studies. Oncotarget, 2016, 7(29): 45283-45301.
11.	Pantzaris ND, Platanaki C, Pierrako C, et al. Neutrophil-to-lymphocyte ratio relation to sepsis severity scores and inflammatory biomarkers in patients with community-acquired pneumonia: a case series. J Transl Int Med, 2018, 6(1): 43-46.
12.	Nazik S, Avci V, Kusku Kiraz Z. Ischemia-modified albumin and other inflammatory markers in the diagnosis of appendicitis in children. Ulus Travma Acil Cerrahi Derg, 2017, 23(4): 317-321.
13.	Yazar FM, Urfalioglu A, Bakacak M, et al. Efficacy of the evaluation of inflammatory markers for the reduction of negative appendectomy rates. Indian J Surg, 2018, 80(1): 61-67.
14.	Markar SR, Karthikesalingam A, Falzon A, et al. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg, 2010, 110(5): 543-547.
15.	Kahramanca S, Ozgehan G, Seker D, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg, 2014, 20(1): 19-22.
16.	Yazar FM, Bakacak M, Emre A, et al. Predictive role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosis of acute appendicitis during pregnancy. Kaohsiung J Med Sci, 2015, 31(11): 591-596.
17.	Blumfield E, Nayak G, Srinivasan R, et al. Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients. AJR Am J Roentgenol, 2013, 200(5): 957-962.
18.	Tulin-Silver S, Babb J, Pinkney L, et al. The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatr Radiol, 2015, 45(6): 820-830.
19.	Kim MS, Park HW, Park JY, et al. Differentiation of early perforated from nonperforated appendicitis: MDCT findings, MDCT diagnostic performance, and clinical outcome. Abdom Imaging, 2014, 39(3): 459-466.

1. Addiss DG, Shaffer N, Fowler BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol, 1990, 132(5): 910-925.
2. 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(2): 185-190.
3. Collaborative S, Cuschieri J, Florence M, et al. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg, 2008, 248(4): 557-563.
4. Ali N, Aliyu S. Appendicitis and its surgical management experience at the University of Maiduguri Teaching Hospital Nigeria. Niger J Med, 2012, 21(2): 223-226.
5. Bhangu A, Soreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet, 2015, 386(10000): 1278-1287.
6. Minneci PC, Mahida JB, Lodwick DL, et al. Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis. JAMA Surg, 2016, 151(5): 408-415.
7. 祝孟川, 曾永娟, 刘登瑞, 等. 阑尾切除术与抗生素比较治疗急性单纯性阑尾炎疗效和安全性的Meta分析. 中国循证医学杂志, 2017, 17(2): 188-194.
8. Yu CW, Juan LI, Wu MH, et al. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg, 2013, 100(3): 322-329.
9. Galizia G, Lieto E, Zamboli A, et al. Neutrophil to lymphocyte ratio is a strong predictor of tumor recurrence in early colon cancers: A propensity score-matched analysis. Surgery, 2015, 158(1): 112-120.
10. Qi X, Li J, Deng H, et al. Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma: A systematic review and meta-analysis of observational studies. Oncotarget, 2016, 7(29): 45283-45301.
11. Pantzaris ND, Platanaki C, Pierrako C, et al. Neutrophil-to-lymphocyte ratio relation to sepsis severity scores and inflammatory biomarkers in patients with community-acquired pneumonia: a case series. J Transl Int Med, 2018, 6(1): 43-46.
12. Nazik S, Avci V, Kusku Kiraz Z. Ischemia-modified albumin and other inflammatory markers in the diagnosis of appendicitis in children. Ulus Travma Acil Cerrahi Derg, 2017, 23(4): 317-321.
13. Yazar FM, Urfalioglu A, Bakacak M, et al. Efficacy of the evaluation of inflammatory markers for the reduction of negative appendectomy rates. Indian J Surg, 2018, 80(1): 61-67.
14. Markar SR, Karthikesalingam A, Falzon A, et al. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg, 2010, 110(5): 543-547.
15. Kahramanca S, Ozgehan G, Seker D, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg, 2014, 20(1): 19-22.
16. Yazar FM, Bakacak M, Emre A, et al. Predictive role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosis of acute appendicitis during pregnancy. Kaohsiung J Med Sci, 2015, 31(11): 591-596.
17. Blumfield E, Nayak G, Srinivasan R, et al. Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients. AJR Am J Roentgenol, 2013, 200(5): 957-962.
18. Tulin-Silver S, Babb J, Pinkney L, et al. The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatr Radiol, 2015, 45(6): 820-830.
19. Kim MS, Park HW, Park JY, et al. Differentiation of early perforated from nonperforated appendicitis: MDCT findings, MDCT diagnostic performance, and clinical outcome. Abdom Imaging, 2014, 39(3): 459-466.

Chinese Journal of Evidence-Based Medicine

The predictive value of neutrophil-to-lymphocyte ratio in the diagnosis of children complicated appendicitis

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