Diagnostic value of the derived neutrophil-to-lymphocyte ratio for acute appendicitis.

Abstract

Background: The diagnosis of appendicitis in children can present several challenges, leading to an increased risk of complications. Herein, we aimed to evaluate the diagnostic value of the derived neutrophil-to-lymphocyte ratio (dNLR) as a novel adjunctive diagnostic tool for appendicitis.

Methods: Diagnostic study of patients with appendicitis and non-surgical abdominal pain (AP) admitted to our hospital between 2020 and 2022. White blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), and dNLR were compared between the two groups of patients.

Results: Overall, 202 patients were enrolled: 101 with appendicitis (69% male, age 9.9 years) and 101 with AP (56% male, age 9.4 years). WBC, NLR, and dNLR were higher in patients in the appendicitis group than in those in the AP group (16.47 versus 11.18 × 10³ cells/mm³; 9.5 versus 3.3; and 5.2 versus 2.3; P ≤ 0.0001, respectively). The sensitivity, specificity, positive predictive value, area under ROC curve, and cutoff point of dNLR for the diagnosis of appendicitis were 71%, 74%, 73%, 0.811, and 3.78, respectively. The positive likelihood ratios for WBC, NLR, and dNLR were 1.95, 2.05 and 2.77.

Conclusion: dNLR is a novel and noninvasive biomarker with high accuracy for diagnosing appendicitis. Its inclusion as an additional diagnostic tool in clinical practice may aid in determining the need for further studies in cases with ambiguous presentations and a dNLR value ≥3.78.