The Role of Inflammatory Ratios: Neutrophils to Lymphocytes Ratio, Platelet to Lymphocyte Ratio, and C-reactive Protein to Platelets Ratio in Diagnosis of Acute Appendicitis and Its Severity
Background: Acute appendicitis is one of the most common surgical emergencies encountered in clinical practice. New inflammatory markers, named neutrophils/lymphocytes ratio (NLR), platelet/ lymphocyte ratio (PLR), and C-reactive protein /platelets ratio (CRP/PLT), have been implemented recently in clinical practice for the diagnosis and assessment prognosis of many conditions like malignancies, cardiovascular diseases, and end-stage renal disease. However, none of those markers have been well studied in acute appendicitis. In this article, the role of NLR, PLR, and CRP/PLT in diagnosing acute appendicitis and the correlation of their values to the severity of the disease has been studied. Methods: A retrospective study was conducted on 346 patients of all ages and genders who were admitted to Al-Makassed Islamic Charitable Hospital in Palestine for three years, from 2018 to 2021, with the diagnosis of acute appendicitis. Complete blood count and CRP were reviewed. NLR, PLR, and CRP/PLT ratios were calculated and compared between divided groups according to the age and severity of the disease. A T-test was used for the analysis of the results. Results: Neither NLR nor PLR showed a statistically significant association with the diagnosis of acute appendicitis or prediction of its severity. Regarding CRP/PLT ratio, it was 0.202±0.431in the pediatric group who were diagnosed with acute appendicitis and 0.039±0.061 in the pediatric group who had normal appendix (P value of 0.029), while it was 0.194±0.316 in adult appendicitis group and 0.107±0.132 in an adult group with normal appendix (P value of 0.567). The CRP/PLT ratio in the pediatric group who had uncomplicated acute appendicitis was 0.186±0.452 compared to 0.305±0.323 in complicated appendicitis (P value of 0.001), while the ratio in the adult simple appendicitis group was 0.154±0.293 compared to complicated cases that were 0.426±0.345 (P value of <0.001). Conclusion: Based on a complete analysis of the novel inflammatory markers in the two age groups, pediatrics, and adults, in both simple and complicated acute appendicitis, only the CRP/PLT ratio showed high accuracy for diagnosis of acute appendicitis in pediatrics and distinguishing complicated cases from simple ones in both pediatric and adult age groups.
Digital Object Identifier (DOI)
Sulaiman, Motaz; Abbas, Abbas; Al-Zyoud, Raed; Al-Shawa, Khaled; and Maree, Mohammad
"The Role of Inflammatory Ratios: Neutrophils to Lymphocytes Ratio, Platelet to Lymphocyte Ratio, and C-reactive Protein to Platelets Ratio in Diagnosis of Acute Appendicitis and Its Severity,"
Palestinian Medical and Pharmaceutical Journal: Vol. 8
, Article 7.
Available at: https://doi.org/10.59049/2790-0231.1143