Investigation of the Diagnostic Value of Neutrophil to Lymphocyte Ratio in Pediatric Appendicitis Cases

Background: Abdominal pain is one of the most common complaints and appendicitis is the most common etiology of acute abdominal pain in the emergency departments for pediatric population. Objectives: The current study aimed at evaluating the diagnostic reliability of neutrophil to lymphocyte ratio in the appendicitis in pediatric population. Methods: The current retrospective descriptive study screened pediatric patients (< 18 years old) with appendectomy from January 1, 2012 to December 31, 2013 in a tertiary care setting. Data were collected via electronic hospital databases. Histopathological reports were used as the gold standard of the diagnosis and patients were divided into 2 groups of acute appendicitis (AA) and non-appendicitis (NA), according to pathologic reports. Neutrophil to lymphocyte ratio was calculated by the initial laboratory results of the patients. Statistical analysis was performed by Statistical Package for the Social Sciences (SPSS) version 15.0 (SPSS Inc., Chicago, IL). Results: A total of 658 subjects were included in the study and 628 of them were in the AA group. There was no difference in age and gender between the 2 groups (P values = 0.872 and 0.182, respectively). White blood cell (WBC) count (P = 0.012), neutrophil count (P < 0.001), lymphocyte count (P < 0.001), and neutrophil-to-lymphocyte ratio (NLR) (P = 0.008) were different between the 2 groups. The results of area under the curve (AUC), according to receiver operating characteristics (ROC) analysis, were as follows: 0.669 for white blood cell count, 0.675 for neutrophil count, 0.300 for lymphocyte count, and 0.694 for neutrophil-to-lymphocyte ratio. With a cutoff value of 3.5, sensitivity and specificity were 84.2% and 56.7%, respectively. Conclusions: Neutrophil-to-lymphocyte ratio seems a good predictor in the diagnosis of acute appendicitis in pediatric population.