Highlights
- •Neutrophil-to-lymphocyte ratio (NLR) can potentially predict both diagnosis and severity of appendicitis.
- •NLR >4.7 was independent predictor of appendicitis and NLR >8.8 was independent predictor of complicated appendicitis.
- •NLR can be used for prioritising cases for surgery, for monitoring conservatively treated patients and for patients who do not routinely undergo CT scan.
Abstract
Objectives
to investigate whether Neutrophil-to-lymphocyte ratio (NLR) can predict acute appendicitis
and whether it can distinguish between uncomplicated and complicated appendicitis.
Methods
A search of electronic information sources was conducted to identify all studies reporting
NLR in patients with clinical suspicion or confirmed diagnosis of acute appendicitis.
We considered two comparisons:1) appendicitis versus no appendicitis; 2) uncomplicated
appendicitis versus complicated appendicitis. ROC curve analysis was performed to
determine cut-off values of NLR for appendicitis and complicated appendicitis.
Results
Seventeen studies, enrolling 8,914 patients were included. NLR of 4.7 was cut-off
value for appendicitis with sensitivity of 88.89% and specificity of 90.91% with AUC
of 0.96. NLR of 8.8 was cut-off value for complicated appendicitis with sensitivity
of 76.92% and specificity 100% with AUC of 0.91. NLR >4.7 was predictor of acute appendicitis
(OR:128,P < 0.0001) and, NLR >8.8 was predictor of complicated appendicitis (OR:43,P < 0.0001).
Conclusions
NLR predicts both diagnosis and severity of appendicitis. This may have implications
for prioritising cases for surgery, for monitoring conservatively treated patients
and for patients who do not routinely undergo CT scan (pregnant or paediatric patients).
Keywords
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Article info
Publication history
Published online: April 27, 2019
Accepted:
April 19,
2019
Received in revised form:
March 31,
2019
Received:
February 5,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
