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Neutrophil/lymphocyte ratio is a valuable data to reduce negative laporotomy rates in emergency department

Eylem Kuday Kaykisiz, Pinar Yesim Akyol, Zeynep Karakaya, Umut Payza, Fatih Esad Topal

Introduction: Acute appendicitis (AA) may interfere many diseases and appendectomy is the most performed intra-abdominal operation in the world. Despite of the use of advanced technology diagnostic methods, it is not shown a decrease in perforation and negative appendectomy (NA) rates. The aim of this study is to identify the effect of neutrophil/lymphocyte ratio (NLR) in reducing the NA.

Methods: 341 patients who have operated with initial diagnosis of AA in a tertiary care hospital between 01.01-31.12.2014 were included in this study. The patients who had taking antibiotics before admission, trauma or cancer history, pregnancy and under age of 17 were excluded. Histopathologic reports of 318 patients who met criteria’s were evaluated and the patients divided into 3 groups in terms of histopathologic reports as non-AA (group 1), AA (group 2) and complicated appendicitis (group3). NLR values were compared between groups.

Results: 318 patients included in this study; 196 of these were male and 122 of these were female. The mean age of males were 33.29 ± 13 and of females 32.8 ± 13.25. There were no statistically significant differences between groups in terms of age. 15.7% (n=50) of the patients were in non-AA group however 79.2% (n=252) of the patients had the diagnosis of AA and 5% (n=16) of the patients had the diagnosis of complicated appendicitis. Cut-off value of NLR determined 4.659; sensitivity of 69% and specificity of 70% in predicting AA and NLR was statistically significant to differentiate non-AA from AA but there was no statistically significance to differentiate AA from complicated appendicitis.

Conclusion: AA is one of the most frequent emergency surgical problems of the patients with abdominal pain. Timely and accurate diagnosis is essential, on the other hand high NA rates are continuing an important problem so simple, fast and reliable tests are necessary to definitive diagnosis. As a result of our study, we found out that preoperative NLR is a valuable data for this purpose. We hope that our study may contribute to developing new protocols for definitive diagnosis in emergency department.