Preoperative Neutrophil-to-Lymphocyte Ratio as a Predictive Marker of Postoperative Infectious Complications in Pediatric Patients With Acute Appendicitis

Background Several studies have investigated the role of neutrophil-to-lymphocyte ratio (NLR) in diagnosing and predicting the severity of acute appendicitis; however, few studies have analyzed its usefulness in pediatric appendicitis patients particularly in predicting postoperative complications. We investigated the role of NLR and assessed its clinical utility as a predictor of postoperative infectious complications in children with acute appendicitis. Methodology We performed a prospective cross-sectional study from July 2023 to July 2024 on 135 pediatric patients aged five to 12 years undergoing emergency appendectomy and having operative findings or histopathological confirmation of appendicitis. NLR was calculated from differential leucocyte count at the time of presentation to the emergency department. Patients were followed for one month after surgery for the development of complications. Univariate and multiple logistic regression was used to identify clinical factors significantly associated with postoperative complications. The sensitivity and specificity of these parameters to predict complications were determined using receiver operating characteristic curves. Results The average age was 8.36 ± 2.38 years. There were 36 (26.67%) laparoscopic and 99 (73.33%) open appendectomies. Eighty-three (61.48%) patients had simple while 52 (38.52%) had complicated appendicitis. NLR, platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) were significantly higher in patients with complicated appendicitis (p < 0.05). Twenty-nine patients (21.48%) developed complications like wound infection (n = 29, 21.48%), wound dehiscence (n = 5, 3.7%), prolonged ileus (n = 12, 8.89%), intra-abdominal abscess (n = 7, 5.19%), and early adhesive obstruction (n = 4, 2.96%). Univariate and multiple logistic regression analysis of the clinical parameters revealed that NLR (OR: 1.28; 95% CI: 1.004-1.64), PLR (OR: 1.01, 95% CI: 1.001-1.01), and type of appendicitis (OR: 7.11; 95% CI: 1.57-32.22) had an independent significant association with all postoperative complications (p < 0.05). NLR and PLR presented an area under the curve (AUC) of 0.86 (p < 0.001) and 0.83 (p < 0.001), respectively, which was significantly higher than the AUC of neutrophil count (AUC: 0.66, p = 0.006), lymphocyte count (AUC: 0.80, p < 0.001), CRP (AUC: 0.70, p = 0.001), and plasma sodium levels (AUC: 0.64, p = 0.006). NLR and PLR showed the highest sensitivity (79.3% and 79.3%) and specificity (95% and 82.1%) at cut-off values of 9.53 and 166.01, respectively. Conclusion The NLR can be used for distinguishing complicated from uncomplicated appendicitis, for prioritizing cases for operative management, and for identifying patients likely to experience complications after surgery.