• Neutrophil to lymphocyte ratio as the marker of acute appendicitis and its destructive forms in children
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Neutrophil to lymphocyte ratio as the marker of acute appendicitis and its destructive forms in children

Paediatric surgery.Ukraine.2020.1(66):35-40; doi 10.15574/PS.2020.66.35
Pereyaslov A. A.1, Bobak A. I.1, Nykyforuk O. M.1, Stenyk R. V.2, Opikan N. M.1, Pereyaslova Z. M.3
1Danylo Halytskyy Lviv National Medical University, Ukraine
2Communal Noncommercial Enterprise of Lviv Regional Council Lviv Regional Children’s Clinical Hospital «OHMATDYT», Ukraine
3Lviv 3rd city clinical hospital, Ukraine

For citation: Pereyaslov AA, Bobak AI, Nykyforuk OM, Stenyk RV et al.(2020). Neutrophil to lymphocyte ratio as the marker of acute appendicitis and its destructive forms in children. Paediatric surgery.Ukraine.2020.1(66):35-40; doi 10.15574/PS.2020.66.35
Article received: Nov 07, 2019. Accepted for publication: Mar 11, 2020.

Despite of the well-known symptoms of acute appendicitis, the timely diagnosis in some cases is difficult that lead to adverse consequences and, respectively, need to apply of the new diagnostic criteria. During the last decades the neutrophil to lymphocyte ratio (NLR) as the simple and non-expensive marker of inflammatory process, is in the focus of surgeons. However, the accuracy of this marker for the diagnostic of acute appendicitis and its’ complicated forms are still questionable.
Aim of the study was to evaluate the results of NLR for the diagnostic of acute appendicitis and determination of its’ complicated form (perforative acute appendicitis).
Material and Methods. This study based on the results of retro- and prospective investigation of 3171 children with acute appendicitis, which were operated in 1st surgical department of Lviv regional clinical hospital «OXMATDYT» during 2009-2018 years. The control group consists of 146 children with the suspected acute appendicitis but at the following this diagnosis was rejected. NLR calculated at the time of admission and results compared with the results of histopathological examination.
Results. NLR levels were significantly higher in children with phlegmonous, gangrenous, and perforative acute appendicitis compared with the control group (p<0.001), and only in patients with the catarrhal appendicitis this difference was inconsequential (p>0.05). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the receiver operating characteristic curve (AUC), and the cut-off point of NLR for diagnosis of acute appendicitis among all children were 84.9%, 61.7%, 17%, 98.2%, 0.801, and 2.61, respectively. Simultaneously, the sensitivity, specificity, PPV, NPV, AUC, and cut-off point of NLR for differentiating simple and complicated appendicitis were 90.3%, 89.9%, 98.9%, 46.6%, 0.832, and 10.24, respectively.
Conclusions. The high NLR level help identify patients not only with the high probability of acute appendicitis, but also with its complicated forms (gangrenous and perforation). Moreover, this marker is not expensive to measure, is easily available, and the short time required for analysis is valuable in the emergency department.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
Key words: children, acute appendicitis, diagnostic, neutrophil to lymphocyte ratio.


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