The Diagnostic Value of Neutrophil: Lymphocyte Ratio in Adults with Suspected Acute Appendicitis

Abstract

Aim: To validate the use of neutrophil :lymphocyte ratio (NLR) in diagnosing appendicitis. Materials and methods: Patients who had had an appendicectomy but where no post-operative histology was available and those under the age of 16, or those who had undergone an interval appendicectomy in a non-emergency setting were excluded from this study. The NLR, WCC, CRP and NLR x CRP were recorded for all patients and these were then compared to their postoperative histology. To determine whether NLR on admission to hospital was an independent predictor of positive appendicitis histology, a multiple logistic regression model was constructed, using factors with a p-value of 0.1 or less in univariate analysis.

Results: One thousand one hundred and seventeen (1117) patients who underwent an appendicectomy between January 2005 and January 2009 were included in this study. The median age was 34 years, with a range of 16–94 years. The area under the ROC curve for NLR was 0.836, compared to 0.779 for WCC, 0.732 for CRP and 0.815 for NLR χ CRP. Conclusion: The results of this study suggest that as an adjunct to clinical examination, NLR appears to be of greater diagnostic accuracy than either WCC or CRP alone.

Key Words:

• Appendicitis
• neutrophil
• lymphocyte.

Additional information

Notes on contributors

S.R. Markar

S. R. Markar, M.R.C.S., M.A General Surgery Department Level 7, Addenbrooke’s Hospital Cambridge, UK, CB2 2QQ Tel.: [phone] Fax: [phone] E-mail: [email protected]