Summary
Objectives. The aim of this study was to find out the accuracy of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in diagnosing complicated acute appendicitis.
Material and methods. A retrospective study was performed including patients admitted to the General Surgery Department with suspected acute appendicitis during the period of 2015–2018 years. According to their final histological evaluation and clinical findings patients were divided into ‘complicated appendicitis group’ with diagnosis of gangrenous or perforated acute appendicitis and ‘uncomplicated appendicitis group’ with phlegmonous acute appendicitis. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were calculated using absolute neutrophil, lymphocyte and platelet counts.
Results. A total of 1334 patients were included with 988 patients in ‘uncomplicated appendicitis group’ and 346 in the ‘complicated appendicitis group’. Mean age was 35.48 (±15.64) years. Mean total leukocyte count (14.03±3.96 and 12.70±3.66×109, p<0.0005), as well as C-reactive protein (111.72±95.59 and 27.41±35.91 mg/L, p<0.0005), neutrophil to lymphocyte ratio (8.88±4.97 and 7.54±5.91, p<0.0005) and platelet to lymphocyte ratio (187.79±107.89 and 170.10±84.90, p=0.029) was significantly higher in the ‘complicated appendicitis group’ compared to the ‘uncomplicated appendicitis group’. C-reactive protein concentration was found to be the most accurate marker in diagnosing complicated acute appendicitis (AUC 0.828, cut off score 32.0 mg/L with sensitivity 80.12% and specificity 73.12%) according to receiver operator curve (ROC) analysis. Neutrophil to lymphocyte ratio had AUC 0.604, cut off score 5.54, sensitivity 73.96% and specificity 42.93%, while total leukocyte count had AUC 0.593, cut off score 13.5×109, sensitivity 53.35% and specificity 60.20% and platelet to lymphocyte ratio had AUC 0.540, cut off score 159.86, sensitivity 51.04% and specificity 57.22%.
Conclusions. Neutrophil to lymphocyte ratio as well as platelet to lymphocyte ratio increased significantly in patients with complicated acute appendicitis and can be useful tool in distinguishing between uncomplicated and complicated acute appendicitis.
