Predictive Value of Neutrophil/Lymphocyte Ratios in the Diagnosis of Acute Appendicitis

Objective: The debate on the value of laboratory tests in the diagnosis of acute appendicitis (AA) continues. In this study, we aimed to evaluate the blood count parameters and the diagnostic value of neutrophil/lymphocyte ratio in the diagnosis of acute appendicitis. Method: 851 patients who underwent appendectomy under emergency conditions were included in the study. Patients were divided into 2 groups; Group 1 was negative appendectomy and Group 2 was acute appendicitis. In addition, they were divided into subgroups as 18-39 years, 40-59 years, and 60 years and older. Neutrophil, platelet, lymphocyte count and Neutrophil/lymphocyte ratio were compared in groups and subgroups. Results: There were 146 patients (17.1%) in Group 1 (negative appendectomy group) and 705 patients (82.9%) in Group 2 (acute appendicitis group). Male sex was dominant in Group 2 (p=0.049). Neutrophil count and neutrophil / lymphocyte ratio (NLR) were higher in Group 2 (p<0.001, p<0.001, respectively), whereas in Group 1, lymphocyte count and platelet count were higher (p=0.008, p=0.002, respectively). The cutoff value for NLR was found to be 5.29 in the ROC curve analysis. In this value, NLR sensitivity was found as 57.3%, specificity as 69.9%, positive predictive value as 57,1%, negative predictive value as 69,2%. Multivariate analysis showed that the risk of acute appendicitis was 6.71 times higher in patients with NLR I5.29 (OR: 6.71+0.28; 95% CI: 6,150-7,276; p=0.024). In subgroups, the cut-off point for NLR was 5.10 for 18-39 years; 6.63 for 40-59 years; and 5.80 for 60 years and older. The highest sensitivity for these cut-off points was in the age group of 60 and over with 69%, while the highest specificity was in the 40-59 years age group with 58.2%. Conclusion: Although the sensitivity and specificity of neutrophil /lymphocyte ratio (NLR) varies according to age groups, it is a useful and helpful parameter for physical examination and other diagnostic methods in the diagnosis of acute appendicitis.