Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for clinical diagnosis of complicated appendicitis in children

Background: Appendicitis is defined as inflammation of appendix and complicated appendicitis is defined as perforated appendicitis, peri appendicular abscess or peritonitis. Objective: The aim of this study was to evaluate the role of neutrophil-to-lymphocyte ratio and platelet- to-lymphocyte ratio in identifying complicated appendicitis. Methodology: This prospective observational study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu (Children) Hospital and Institute, Dhaka from February 2021 to September 2022 among 69 cases patients admitted with suspicion of acute appendicitis in Bangladesh Shishu Hospital and Institute during study period which were confirmed histopathologically after operation. Data were collected using a data collection sheet. Results: Study found, most of the study population belonged to the age group of 6-11 years of age. Among total 69 patients, near about two third (45, 65.2%) were males and the rest one third (24, 34.8%) were females. In order to determine the cut off value for NLR and PLR to discriminate uncomplicated from complicated appendicitis, receiver operating characteristics (ROC) curves were established. The area under curve (AUC) in ROC curve for neutrophil lymphocyte ratio in differentiating between uncomplicated appendicitis and complicated appendicitis was (AUC, 0.933; 95% confidence interval [CI], 0.878-0.989) and for platelet lymphocyte ratio was (AUC, 0.845; 95% confidence interval [CI], 0.573-0.827). Positive and negative predictive value of neutrophil lymphocyte ratio and platelet lymphocyte ratio in differentiating between uncomplicated appendicitis and complicated appendicitis were determined. Comparison of mean of neutrophil lymphocyte ratio and platelet lymphocyte ratio by presence of complications. Histopathology of resected appendix was obtained as gold standard to differentiate complicated appendicitis from uncomplicated appendicitis. Conclusion: NLR and PLR can be used synergistically to identify more severe cases of acute appendicitis and serve as valuable tools in clinical decision-making for pediatric appendicitis.