Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Predictors of Complicated Acute Appendicitis in Children: A Retrospective Cohort Study.

INTRODUCTION

Acute appendicitis is a common pediatric emergency, but its severity is difficult to establish since conventional clinical, laboratory, and imaging methods are often imprecise, leading to unnecessary investigations or delayed care. Recent results suggest that basic inflammatory markers, especially neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, may be beneficial in predicting severe appendicitis, although pediatric-specific data are still scarce. This study seeks to investigate the predictive value of these ratios for complications in children, compare their diagnostic accuracy, and determine if the inclusion of these markers in routine assessment can reduce negative appendectomy rates and enhance clinical decision-making.

METHODS

The study was conducted at Prince Sultan Military Medical City from September 2021 to January 2024. All pediatric patients with a diagnosis of acute appendicitis were included. Descriptive analysis was primarily done. Categorical variables were presented as frequencies and percentages, and the chi-squared test was used to compare both groups, with p-values, degrees of freedom, and odds ratios reported. The analysis was preceded by an ethical permission from the institutional review board of the hospital.

RESULTS

We included a total of 211 children who had undergone laparoscopic appendectomy. Of these, 176 (83.4%) had histologically confirmed appendicitis, and 35 (16.6%) had negative appendectomies. The neutrophil-to-lymphocyte ratio was significantly greater in the confirmed appendicitis patients, but the platelet-to-lymphocyte ratio did not indicate any significant difference. Both ratios were significantly higher in complicated acute appendicitis among confirmed cases. The receiver operating characteristic curve study revealed that neutrophil-to-lymphocyte ratio had higher discriminatory accuracy than platelet-to-lymphocyte ratio (area under the curve (AUC): 0.714 vs. 0.690), with both having intermediate sensitivity and specificity. These data suggest that ratios are a useful supplementary biomarker for the prediction of complex appendicitis in children.

CONCLUSION

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio can be beneficial in the diagnosis of complicated acute appendicitis, with neutrophil-to-lymphocyte ratio being more accurate. Nevertheless, both should be used together with clinical and radiographic assessment.