, UNVER M1
, YOLDAS O1
, DIZEN H2
, EROL V3
, BOZBIYIK O4 ,GUNER M5
, PEHLIVANOGLU K5
, KEBAPCI E5
, AYDIN C5
İzmir University Faculty of Medicine, Department of General Surgery -2
Eskişehir Yunus Emre State Hospital, Department of
General Surgery - 3
Baskent University Faculty of Medicine, Department of General Surgery - 4
Ege University Faculty of Medicine,
Department of General Surgery - 5
Tepecik Education and Research Hospital, Department of General Surgery, Turkey
Introduction: Acute appendicitis (AA) is one of the most common causes of abdominal pain and emergent abdominal surgery.
The incidence is approximately 10% during the lifetime. Although appendectomy is a most common surgical procedure worldwide,
it’s complication rate is 5-28% A delay in diagnosis of AA is associated with prolonged hospitalization, an increased rate of perforation
(34%-75%), wound infection (0%-11%), pelvic abscess (1%-5%) and late intra-abdominal adhesions. Appendectomy is first
described by McBurney in 1894 and still remains the standart procedure for AA. Although patients with AA often present with a characteristic
symptom complex and physical findings, atypical presentations are common. The aim of this study was to assess the diagnostic
value of neutrophil-to-lymphocyte ratio (NLR) in patients who were operated for suspected acute appendicitis and to assess
the discriminative effect of this ratio between uninflamed, uncomplicated and complicated appendicitis.
Materials and methods: The medical records of 3212 patients who underwent appendectomy for suspected acute appendicitis
during a 10-year period were reviewed retrospectively. Patients were divided into 3 groups; group 1, 208 consecutive patients who
had uninflamed appendix at appendectomy; group 2, 2111 consecutive patients who had uncomplicated acute appendicitis at appendectomy;
group 3, 893 patients who had complicated appendicitis (perforated appendix or peri-appendicular abscess) at appendectomy.
Data for three groups of patients were analyzed to calculate the sensitivity and specificity of the NLR in the diagnosis of acute
appendicitis. Receivers operating characteristic (ROC) curves were used to evaluate this ratio in a relation with true diagnosis and
severity of acute appendicitis.
Results: 1792 (55.8%) of the patients were male and 1420 (44.2%) of them were female. The mean age of the groups were
30.28±14.18, 29.98 ± 12.63 and 33.81±16.27 respectively. The discriminative effect of NLR was higher between uninflamed and complicated
appendicitis groups with a cut-off value of 3,94. The recommended cut-off value of the preoperative NLR was decided using
ROC curve analyses. The recommended cut-off value of the NLR was based on the most prominent point on the ROC curve for sensitivity
(82.2%) and specificity (56.5%). The area under the ROC curve was 0.74.
Conclusion: AA is one of the most common surgical emergencies and the most common source of infection in communityacquired
intra-abdominal infections. However the diagnosis is often challenging and the decision to operate, observe or further
work-up on a patient is often unclear. Initial management of patients with suspected AA is based on the history of the patient, physical
examination, basic laboratory tests reflecting the inflammatory response and radiologic imaging. NLR is a helpful biochemical
parameter for the diagnosis of acute appendicitis but it has limited value on differentiating patients with complicated appendicitis
from patients with uninflamed and uncomplicated appendicitis.
Appendicitis, Receiver operating characteristic curve, neutrophil to lymphocyte ratio