Diagnostic accuracy of neutrophilic to lymphocytic ratio in diagnosis of acute appendicitis
DOI:
https://doi.org/10.55629/pakjpathol.v36i4.973Abstract
Objective: The goal of this study was to determine the diagnosis accuracy of the Neutrophilic to Lymphocytic Ratio (NLR) in diagnosing acute appendicitis in terms of the histopathology as a gold standard.
Material and Methods: This cross-sectional validation study was conducted at the Department of General Surgery, Federal Government Polyclinic (PGMI) Hospital, Islamabad, from May to November 2025. A total of 276 patients aged 15–60 years with suspected acute appendicitis were enrolled using non-probability consecutive sampling. Inclusion criteria were right iliac fossa pain and tenderness, while patients with autoimmune diseases, chronic infections, prior appendectomy, or antibiotic use were excluded. Preoperative neutrophil and lymphocyte counts were recorded, and all patients underwent emergency appendectomy. Histopathological examination served as the gold standard. The diagnostic performance of the neutrophil-to-lymphocyte ratio (NLR) at a cutoff of 4.7 was evaluated using sensitivity, specificity, PPV, NPV, and overall accuracy.
Results: Appendicitis was diagnosed using histopathology in 180 (65) patients. The sensitivity, specificity, PPV, NPV, and the general diagnostic accuracy of 90 were obtained with the NLR of 4.7 and above. The receiver operating characteristic (ROC) curve showed the area under the curve (AUC) of 0.937 which is very high.
Conclusion: An NLR cutoff of ≥4.7 was strongly associated with acute appendicitis. These findings suggest that NLR is a simple, rapid, and cost-effective adjunct to clinical assessment and imaging, particularly in low-resource settings. However, multicenter studies are needed to validate these results and refine diagnostic cutoffs.
Keywords: Acute appendicitis, Diagnostic, Histopathology, Inflammatory, Neutrophil-to-lymphocyte ratio
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