Alper Adir, Aronov Yizhak, Shlomov Lior, Zmora Osnat
Shamir Medical Center, Be'er Ya'acov, Israel.
Department of Pediatric Surgery, Shamir Medical Center, Be'er Ya'acov, Israel.
J Clin Lab Anal. 2025 Jun;39(12):e70048. doi: 10.1002/jcla.70048. Epub 2025 May 3.
Diagnosing appendicitis in pediatric patients remains a clinical challenge, especially in resource-limited settings where imaging tools are less accessible. Inflammatory markers, including the Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Neutrophil-to-Monocyte Ratio (NMR), Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Platelet Ratio (NPR), and C-reactive protein (CRP), offer a promising approach to enhancing diagnostic accuracy. We aimed to evaluate the utility of these inflammatory markers to diagnose appendicitis.
This retrospective study included 1027 pediatric patients who underwent appendectomy, with appendicitis confirmed histopathologically in 891 cases. Preoperative Inflammatory markers (NLR, MLR, NMR, PLR, NPR, and CRP) were analyzed and optimal cutoff values were determined using Receiver Operating Characteristic (ROC) curves.
Elevated NLR, NMR, PLR, NPR, and CRP were strongly associated with appendicitis, while an inverse relationship was observed with MLR. NLR (≥ 4.42) and NPR (≥ 0.0327) demonstrated high diagnostic accuracy with sensitivity and specificity exceeding 75%. Surprisingly, MLR showed a statistically significant inverse relationship with AA risk. Temperature differences between groups were not statistically significant.
Each suggested novel inflammatory marker has the potential to improve the preoperative diagnosis of appendicitis in pediatric patients. Such a system could minimize reliance on imaging and expedite decision-making, especially in resource-constrained settings. Further prospective studies are needed to validate these findings and explore their clinical utility.
诊断小儿阑尾炎仍然是一项临床挑战，尤其是在资源有限、难以获得影像检查工具的环境中。包括中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、中性粒细胞与单核细胞比值（NMR）、血小板与淋巴细胞比值（PLR）、中性粒细胞与血小板比值（NPR）以及C反应蛋白（CRP）在内的炎症标志物，为提高诊断准确性提供了一种有前景的方法。我们旨在评估这些炎症标志物在诊断阑尾炎中的效用。
这项回顾性研究纳入了1027例行阑尾切除术的小儿患者，其中891例经组织病理学确诊为阑尾炎。分析术前炎症标志物（NLR、MLR、NMR、PLR、NPR和CRP），并使用受试者工作特征（ROC）曲线确定最佳临界值。
NLR、NMR、PLR、NPR和CRP升高与阑尾炎密切相关，而MLR与之呈负相关。NLR（≥4.42）和NPR（≥0.0327）显示出较高的诊断准确性，敏感性和特异性均超过75%。令人惊讶的是，MLR与阑尾炎风险呈统计学显著负相关。组间体温差异无统计学意义。
每种新提出的炎症标志物都有可能改善小儿阑尾炎的术前诊断。这样一个系统可以减少对影像检查的依赖并加快决策，尤其是在资源有限的环境中。需要进一步的前瞻性研究来验证这些发现并探索其临床效用。
