Delgado-Miguel Carlos, Muñoz-Serrano Antonio, San Basilio María, Miguel-Ferrero Miriam, de Ceano-Vivas María, Martínez Leopoldo
Pediatric Surgery Department, La Paz Children's Hospital, Madrid, Spain.
Pediatric Surgery Department, La Paz Children's Hospital, Madrid, Spain.
An Pediatr (Engl Ed). 2023 Jan;98(1):12-18. doi: 10.1016/j.anpede.2022.08.005. Epub 2022 Sep 7.
The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory biomarker that is easily calculated with data from the differential white blood cell count. The aim of our study was to analyse the role of the NLR in the detection of negative appendectomies and to compare its usefulness with other clinical, sonographic and laboratory factors previously described.
We conducted a retrospective study in patients aged less than 16 years who underwent appendectomy in our hospital between 2017 and 2020. We divided patients into 2 groups based on appendiceal histological findings: NA group (negative appendicitis: absence of appendiceal inflammation) and PA group (positive appendicitis: presence of inflammation in any layer of the appendiceal wall). We analysed demographic, clinical, sonographic and laboratory characteristics.
We included a total of 1269 patients, 1244 in the PA group and 25 in the NA group, with no differences between groups in demographic characteristics. The proportion of patients that presented with nausea and vomiting was significantly smaller in the NA group compared to the PA group (P < .001), and there were no other differences in symptoms. The appendiceal diameter on ultrasound was significantly smaller in the NA group (8.1 ± 2.1 vs. 9.7 ± 2.8 mm; P < .001). The white blood cell and neutrophil counts and the NLR were significantly higher in the PA group (P < .001), as was the level of C-reactive protein (18.6 vs. 2.6; P = .005). The ROC curve analysis revealed that the NLR was the parameter with the highest AUC (0.879) for the diagnosis of negative appendicitis, with a cut-off point of 2.65 for a maximum sensitivity of 84.2% and specificity of 83.8%.
The NLR is the preoperative parameter that best discriminates patients without acute appendicitis. Values of less than 2.65 should make clinicians contemplate diagnoses other than appendicitis.
中性粒细胞与淋巴细胞比值（NLR）是一种炎症生物标志物，可通过白细胞分类计数数据轻松计算得出。我们研究的目的是分析NLR在阴性阑尾切除术检测中的作用，并将其与先前描述的其他临床、超声和实验室因素的效用进行比较。
我们对2017年至2020年期间在我院接受阑尾切除术的16岁以下患者进行了一项回顾性研究。根据阑尾组织学检查结果将患者分为两组：NA组（阴性阑尾炎：阑尾无炎症）和PA组（阳性阑尾炎：阑尾壁任何一层存在炎症）。我们分析了人口统计学、临床、超声和实验室特征。
我们共纳入1269例患者，PA组1244例，NA组25例，两组在人口统计学特征上无差异。与PA组相比，NA组出现恶心和呕吐的患者比例显著更小（P<0.001），且在症状方面无其他差异。NA组超声检查时阑尾直径显著更小（8.1±2.1 vs. 9.7±2.8 mm；P<0.001）。PA组的白细胞和中性粒细胞计数以及NLR显著更高（P<0.001），C反应蛋白水平也是如此（18.6 vs. 2.6；P = 0.005）。ROC曲线分析显示，NLR是诊断阴性阑尾炎时AUC最高的参数（0.879），截断点为2.65，最大灵敏度为84.2%，特异性为83.8%。
NLR是术前最能区分无急性阑尾炎患者的参数。小于2.65的值应使临床医生考虑阑尾炎以外的诊断。
