Eun S, Ho I G, Bae G E, Kim H, Koo C M, Kim M K, Yoon S H
Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):7097-7107. doi: 10.26355/eurrev_202111_27263.
Acute appendicitis (AA) is one of the most common surgical emergencies and causes of acute abdominal pain in the pediatric population. However, it can be difficult to diagnose in children. We aimed to provide updated evidence on the diagnostic utility of the neutrophil-to-lymphocyte ratio (NLR) for AA, along with other conventional biomarkers, in pediatric patients.
We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for eligible articles published up to May 16, 2021.
We included 19 studies comprising a total of 5,974 pediatric cases. The overall sensitivity and specificity of the NLR were 0.82 (95% confidence interval [CI]: 0.79-0.85) and 0.76 (95% CI: 0.69-0.81), respectively. The overall diagnostic odds ratio was 14.34 (95% CI: 9.05-22.73). The area under the summary receiver operating characteristic curve was 0.86 (95% CI: 0.83-0.89). The pooled sensitivity and specificity of other biomarkers were as follows: 0.79 (95% CI: 0.71-0.86) and 0.66 (95% CI: 0.54-0.77) for the white blood cell count, 0.73 (95% CI: 0.69-0.77) and 0.68 (95% CI: 0.55-0.79) for the C-reactive protein level, 0.75 (95% CI: 0.65-0.82) and 0.78 (95% CI: 0.72-0.83) for the absolute neutrophil count, and 0.83 (95% CI: 0.79-0.87) and 0.68 (95% CI: 0.53-0.80) for the neutrophil percentage, respectively.
The NLR has moderate predictive power for AA and can be used as a simple, auxiliary tool for diagnosis. NLR can also help clinicians decide whether to perform imaging testing when the clinical symptoms or physical examination findings are vague.
急性阑尾炎（AA）是儿科最常见的外科急症之一，也是儿童急性腹痛的常见病因。然而，儿童阑尾炎的诊断可能具有挑战性。我们旨在提供关于中性粒细胞与淋巴细胞比值（NLR）以及其他传统生物标志物在儿科患者中对AA诊断效用的最新证据。
我们检索了截至2021年5月16日发表的符合条件的文章的PubMed、Embase、Cochrane图书馆和Web of Science数据库。
我们纳入了19项研究，共5974例儿科病例。NLR的总体敏感性和特异性分别为0.82（95%置信区间[CI]：0.79-0.85）和0.76（95%CI：0.69-0.81）。总体诊断比值比为14.34（95%CI：9.05-22.73）。汇总的受试者工作特征曲线下面积为0.86（95%CI：0.83-0.89）。其他生物标志物的合并敏感性和特异性如下：白细胞计数分别为0.79（95%CI：0.71-0.86）和0.66（95%CI：0.54-0.77）；C反应蛋白水平分别为0.73（95%CI：0.69-0.77）和0.68（95%CI：0.55-0.79）；绝对中性粒细胞计数分别为0.75（95%CI：0.65-0.82）和0.78（95%CI：0.72-0.83）；中性粒细胞百分比分别为0.83（95%CI：0.79-0.87）和0.68（95%CI：0.53-0.80）。
NLR对AA具有中等预测能力，可作为一种简单的辅助诊断工具。当临床症状或体格检查结果不明确时，NLR还可帮助临床医生决定是否进行影像学检查。
