Neutrophil Lymphocyte Ratio in Predicting Perforated Appendices in Emergency Settings

Objective: Present study aims to review the Neutrophil Lymphocyte Ratio (NLR) level in patients with acute appendicitis (non-perforated appendix) and those with a complicated perforated appendix, to evaluate the effectiveness of using the NLR level to predict if patients have a complicated perforated appendix.

Introduction: Appendicitis is a common cause of abdominal emergency globally. Many laboratory tests have been utilised to diagnose appendicitis, but no single laboratory test predicts the diagnosis accurately. Several studies proposed that the NLR associated with appendiceal perforation.

Methods: We performed a retrospective study of 308 patients who had undergone an appendectomy during June 2008 to September 2016 in King Abdul Aziz University Hospital. These cases were categorised histologically as an acute non-perforated appendix and complicated perforated or gangrenous appendix. The study also compared the NLR levels of the two groups regarding the mean, sensitivity, and specificity.

Results: Results showed that NLR could be helpful in differentiating perforated appendix from acute appendicitis if cut-off point is 5.7 μmol/l with a sensitivity of 85.70% and specificity of 61.60%.

Conclusion: Mostly in clinical practice, acute appendicitis is diagnosed clinically, confirmed by laboratory investigations and radiological imaging. In addition to that, adding the serum, NLR level is useful in predicting the complicated perforated appendix.