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Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department

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Abstract

Purpose

The diagnostic value of the neutrophil-to-lymphocyte count ratio (NLR) and the Appendicitis Inflammatory Response (AIR) score for identifying acute appendicitis (AA) perforation in elderly patients in the emergency department (ED) were evaluated.

Methods

A total of 103 patients who were admitted for appendectomy for AA via the ED between January 2012 and December 2014 were reviewed retrospectively. Patients aged 65 and over were included. Patient age, sex, comorbidities, body temperature, clinical findings and initial laboratory results including white blood cell (WBC) count, NLR, serum levels of CRP and total bilirubin (TB) in the ED were assessed, and the AIR score was calculated.

Results

Perforation due to AA was identified in 58 (56.3 %) elderly patients. Median WBC count, neutrophil count, CRP and TB were significantly higher in the perforated group compared to the non-perforated group (p = 0.005, p = 0.001, p = 0.004 and p = 0.012) in the ED. The NLR was significantly different in the two groups (perforated vs non-perforated group, 9.5 vs 5.1, p < 0.001). The area under the curve value of NLR was 0.755 (95 % CI 0.660–0.834), and the cutoff value was 5.6 (sensitivity 78.0 % and specificity 65.9 %). In multivariate logistic analysis, NLR > 5.6 [odds ratio (OR) 6.794, p = 0.001] was significant independent factor for AA perforation in elderly patients. The AIR score risk probability did not differ between the two groups of elderly patients (p = 0.094). Twenty-five (42.4 %) patients in the perforated group and five (11.4 %) patients in the non-perforated group were classified as high probability by the modified AIR score including the NLR value (p = 0.001).

Conclusion

We suggest that the initial NLR in the elderly patient is the most powerful predictive factor for the diagnosis of AA perforation in the ED.

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Abbreviations

AA:

Acute appendicitis

ED:

Emergency department

US:

Ultrasound

CT:

Computed tomography

AIR:

Appendicitis Inflammatory Response

NLR:

Neutrophil–lymphocyte ratio

WBC:

White blood cell

CRP:

C-reactive protein

TB:

Total bilirubin

ROC:

Receiver operation characteristic

AUC:

Area under the curve

OR:

Odds ratio

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Acknowledgments

The authors report this study did not receive any outside funding or support.

Authors’ contributions

SKJ and WJL performed data analysis and drafted the manuscript. DHK, SHW and SHS acquired data and critical revisions to the manuscript. DYR and SPC managed the data and revisions to the manuscript. All authors has read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Emergency Medicine, Daejeon St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Daejeon, Republic of Korea

    Si Kyung Jung

  2. Department of Emergency Medicine, Incheon St. Mary’s Hospital, College of Medicine, Catholic University of Korea, #665-8 Bupyeong 6-dong, Bupyeong-gu, Incheon, 403-720, Republic of Korea

    Dong Yoon Rhee, Woon Jeong Lee, Seon Hee Woo, Seung Hwan Seol & Dae Hee Kim

  3. Department of Emergency Medicine, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea

    Seung Pill Choi

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  1. Si Kyung Jung
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Correspondence to Woon Jeong Lee.

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Conflict of interest

The authors do not have any financial or other relationships that might pose any conflicts of interest.

Human and animal rights

All procedures performed in studies involving the patients were in accordance with the ethical standards of the institutional and/or national research. The protocol was approved by the Institutional Review Board of Incheon St. Mary’s Hospital.

Informed consent

As the clinical measurements were part of routine patient management in the emergency department, informed consent was unnecessary, which was confirmed by the institutional review board.

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Jung, S.K., Rhee, D.Y., Lee, W.J. et al. Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department. Aging Clin Exp Res 29, 529–536 (2017). https://doi.org/10.1007/s40520-016-0584-8

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  • DOI: https://doi.org/10.1007/s40520-016-0584-8

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