Khan Sundus A, Ashraf Raza, Hassaan Narmeen, Naseer Mubashar, Azad Muhammad Hassan, Javed Hamza
General Surgery, Northwest School of Medicine, Peshawar, PAK.
General Surgery, Shifa International Hospital, Islamabad, PAK.
Cureus. 2023 Dec 27;15(12):e51164. doi: 10.7759/cureus.51164. eCollection 2023 Dec.
Acute appendicitis (AA), a common reason for episodes of acute abdomen, is a surgical emergency. Its immediate diagnosis and management are of immense significance, as its diagnosis can become challenging at times, especially in resource-limited setups. The goal of this study was to ascertain the threshold value for the neutrophil-to-lymphocyte ratio (NLR) in diagnosing AA and to calculate the validity parameters for the NLR.
A cross-sectional study was carried out involving 108 patients who were admitted to the surgical wards of Ayub Teaching Hospital, Abbottabad with suspicion of AA and subsequently underwent open appendectomy. Data was collected regarding the demography of the patients, physical examination findings, clinical presentations, and investigations including the histopathology and complete blood count, from which the NLR value was computed, and the Statistical Package for Social Sciences (SPSS), version 25.0 (IBM Corp., Armonk, NY) was utilized for the computation. Receiver operating characteristic (ROC) analysis was done to calculate the cut-off value of the NLR for diagnosing AA, and validity parameters were computed, taking into account statistical significance with a p-value < 0.05.
Based on the ROC analysis, a threshold value for NLR indicating a positive appendectomy was determined to be 2.49 (sensitivity = 71.4% and 1-specificity = 12.5%) with an area under the curve of 90.6% (95% confidence interval {CI} 0.818-0.994, p<0.001). The sensitivity, specificity, and diagnostic accuracy of NLR for diagnosing AA were 71.43%, 87.5%, and 72.73%, respectively.
There is a strong correlation between NLR at a cut-off value of 2.49 and the diagnosis of AA. We suggest that NLR should be utilized as a complementary biomarker to clinical examination, aiding in the diagnosis of AA.
急性阑尾炎（AA）是急腹症发作的常见原因，属于外科急症。其及时诊断和处理具有极其重要的意义，因为有时其诊断颇具挑战性，尤其是在资源有限的环境中。本研究的目的是确定中性粒细胞与淋巴细胞比值（NLR）在诊断AA中的阈值，并计算NLR的有效性参数。
开展了一项横断面研究，纳入108例因疑似AA入住阿伯塔巴德阿尤布教学医院外科病房并随后接受开放性阑尾切除术的患者。收集了患者的人口统计学数据、体格检查结果、临床表现以及包括组织病理学和全血细胞计数在内的检查结果，据此计算NLR值，并使用社会科学统计软件包（SPSS）25.0版（IBM公司，纽约州阿蒙克）进行计算。进行受试者操作特征（ROC）分析以计算诊断AA的NLR临界值，并计算有效性参数，同时考虑p值<0.05的统计学显著性。
基于ROC分析，确定阑尾切除术阳性的NLR阈值为2.49（敏感性 = 71.4%，1 - 特异性 = 12.5%），曲线下面积为90.6%（95%置信区间{CI} 0.818 - 0.994，p<0.001）。NLR诊断AA的敏感性、特异性和诊断准确性分别为71.43%、87.5%和72.73%。
NLR临界值为2.49与AA的诊断之间存在强相关性。我们建议NLR应作为临床检查的补充生物标志物，辅助AA的诊断。
