Servicio de Pediatría, Hospital General Regional N.º 1, Delegación Yucatán, Instituto Mexicano del Seguro Social, Mérida, México.
Servicio de Reumatología, Hospital General Regional N.º 1, Delegación Yucatán, Instituto Mexicano del Seguro Social, Mérida, México.
Arch Argent Pediatr. 2022 Oct;120(5):317-324. doi: 10.5546/aap.2022.eng.317. Epub 2022 Aug 12.
Acute appendicitis (AA) in pediatric patients requires an accurate diagnosis. The neutrophil-to-lymphocyte ratio (NLR) is an accessible parameter useful for its diagnosis.
To determine NLR accuracy to diagnose AA in patients with abdominal pain.
Diagnostic test study. A total of 520 patients seen at the Pediatric Emergency Department were included. Diagnostic accuracy was estimated based on sensitivity, specificity, predictive values, and likelihood ratios. A multiple logistic regression model was used to assess the effect of potentially confounding variables in the relationship between NLR and AA.
The prevalence of AA was 49%. For a cutoff point of 5, sensitivity was 85.1%, specificity: 78.9%; positive predictive value: 79.5%; and negative predictive value: 84.6%. However, based on likelihood ratios, the NLR is not powerful enough to diagnose AA (positive likelihood ratio = 4.03 and negative likelihood ratio = 0.18) and did not exhibit diagnostic usefulness in complicated appendicitis (positive likelihood ratio = 1.57 and negative likelihood ratio = 0.55). Following adjustment for age, sex, obesity, time since symptom onset, and analgesic use, the NLR was an explanatory variable for the presence of AA (odds ratio = 23.53; 95% confidence interval: 13.14-42.15).
The NLR alone is not sufficiently accurate to confirm or rule out the presence of AA. However, the NLR can be used together with other tests to select patients in whom further study is necessary.
儿科患者的急性阑尾炎（AA）需要准确的诊断。中性粒细胞与淋巴细胞比值（NLR）是一种可用于诊断的易于获取的参数。
确定 NLR 对诊断腹痛患儿 AA 的准确性。
诊断测试研究。共纳入 520 名在儿科急诊就诊的患者。基于敏感性、特异性、预测值和似然比来评估诊断准确性。使用多变量逻辑回归模型评估 NLR 与 AA 之间关系中潜在混杂变量的影响。
AA 的患病率为 49%。对于 5 的截断值，敏感性为 85.1%，特异性为 78.9%；阳性预测值为 79.5%，阴性预测值为 84.6%。然而，基于似然比，NLR 不足以诊断 AA（阳性似然比=4.03，阴性似然比=0.18），并且在复杂性阑尾炎中没有诊断价值（阳性似然比=1.57，阴性似然比=0.55）。在校正年龄、性别、肥胖、症状出现时间和使用镇痛药后，NLR 是 AA 存在的一个解释变量（比值比=23.53；95%置信区间：13.14-42.15）。
NLR 单独使用不足以确认或排除 AA 的存在。然而，NLR 可以与其他测试一起使用，以选择需要进一步研究的患者。
