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Abstract：
Introduction Acute appendicitis is a common reason for acute abdominal pain. It has a high perforation rate of 20%. Diagnosis of acute appendicitis is usually through well-known clinical signs and symptoms. Radiologic imaging is by and large carried out in peculiar cases with indistinct signs and symptoms. Although various scoring methods are available for screening and diagnosis, those have inadequate validity to accurately predict the severity of acute appendicitis. From the differential counts, the neutrophil-to-lymphocyte ratio (NLR) is an economical and straightforward measure of subclinical inflammation. NLR may be a useful marker for predicting the onset and severity of appendicitis because of the insight it gives into immunological and inflammatory pathways. In this study, we aimed to determine the association between NLR and acute appendicitis among adult patients to differentiate between perforated and non-perforated appendicitis in a tertiary care hospital in Tamil Nadu, India. Methods This was a cross-sectional study conducted in the Department of General Surgery of a deemed university in Chennai, Tamil Nadu. The study was conducted from March 2022 to December 2022. Patients aged 18 years and above undergoing appendicectomy surgery were included in the study. Patients with hematology disorders, chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease, asthma, cancer, or auto-immune diseases, and any viral, bacterial, or parasitic infections were excluded. Pregnant women were also excluded from the study. After obtaining informed consent from the patients, blood samples were collected as and when they were diagnosed as acute appendicitis. Laboratory analysis for complete hemogram including white blood cell (WBC) count, neutrophil, and lymphocyte count was carried out using an automated hematology analyzer. Prevalence of perforated appendicitis was reported as a percentage. The receiver-operating characteristic (ROC) curve was developed for NLR in differentiating perforated and non-perforated appendicitis. Data were entered in Microsoft Excel 2023. These analyses were carried out in STATA 12.0 (StataCorp, College Station, Texas, USA). Results A total of 212 patients aged 18 years and above were included in the study. Among them 93 (43.9%) were male and 119 (56.1%) were female. Prevalence of perforated appendicitis observed intra-operatively was 29.7% and non-perforated appendicitis was 70.3%. The mean (SD) of NLR among patients with perforated appendicitis was 8.8 (5.1) and non-perforated appendicitis was 3.2 (2.4) with a statistically significant difference (p-value < 0.0001). ROC curve with a cut-off value of 3.78 NLR, had sensitivity of 65.9% and specificity of 93.1% in differentiating perforated and non-perforated appendicitis. The positive predictive value (PPV) and negative predictive values (NPV) were reported as 85.7% and 81.2%, respectively. Conclusion NLR has a reasonable validity in differentiating perforated and non-perforated appendicitis. NLR may be useful in low-resource settings where routine confirmatory radiological procedures like computed tomography scans are not available.
摘要：
简介急性阑尾炎是急性腹痛的常见原因。它有20%的高穿孔率。急性阑尾炎的诊断通常是通过众所周知的临床体征和症状。放射学成像通常在体征和症状不明显的特殊病例中进行。尽管各种评分方法可用于筛查和诊断，这些指标不足以准确预测急性阑尾炎的严重程度。从差分计数来看，中性粒细胞与淋巴细胞比值(NLR)是一种经济,简便的亚临床炎症指标.NLR可能是预测阑尾炎发作和严重程度的有用标记，因为它可以深入了解免疫和炎症途径。在这项研究中,我们旨在确定NLR与成人患者急性阑尾炎之间的关联，以区分泰米尔纳德邦三级医院的穿孔和非穿孔阑尾炎，印度。方法这是一项横断面研究，在钦奈一所大学的普外科进行，泰米尔纳德邦.该研究于2022年3月至2022年12月进行。18岁及以上接受阑尾切除术的患者被纳入研究。血液病患者，慢性肾病,慢性肝病,慢性阻塞性肺疾病,哮喘,癌症,或自身免疫性疾病，和任何病毒，细菌,或寄生虫感染被排除。孕妇也被排除在研究之外。在获得患者的知情同意后，在诊断为急性阑尾炎时收集血液样本。完整血象的实验室分析，包括白细胞（WBC）计数，中性粒细胞,淋巴细胞计数使用自动血液学分析仪进行。穿孔性阑尾炎的患病率以百分比报告。建立了NLR区分穿孔和非穿孔阑尾炎的受试者工作特征（ROC）曲线。数据在MicrosoftExcel2023中输入。这些分析在STATA12.0中进行(StataCorp，学院站,德州,美国）。结果共纳入212例18岁及以上患者。其中男性93例（43.9%），女性119例（56.1%）。术中观察到的穿孔性阑尾炎的患病率为29.7％，非穿孔性阑尾炎的患病率为70.3％。穿孔性阑尾炎患者的NLR平均值（SD）为8.8（5.1），非穿孔性阑尾炎患者为3.2（2.4），差异有统计学意义（p值<0.0001）。截止值为3.78NLR的ROC曲线，在区分穿孔和非穿孔阑尾炎方面的敏感性为65.9%，特异性为93.1%。阳性预测值(PPV)和阴性预测值(NPV)分别为85.7%和81.2%,分别。结论NLR对穿孔性和非穿孔性阑尾炎具有合理的鉴别价值。NLR在资源不足的情况下可能很有用，在这种情况下，无法使用常规的确认放射学程序，例如计算机断层扫描。
