Unnecessary appendectomy can cause complications; ways of reducing negative appendectomy rates (NAR) using biochemical and imaging methods are desirable. We retrospectively examined 640 patients who underwent appendectomy for suspected AA. Patients with histologically confirmed appendicitis were designated the positive appendectomy group (n = 565), whereas those with unconfirmed appendicitis were designated the negative appendectomy group (n = 75). The positive appendectomy group was subdivided into the non-perforated (n = 511) and perforated (n = 54) appendectomy groups according to pathology reports. We compared the age, sex, lymphocyte count, neutrophil percentage, pathologic positivity or negativity for appendicitis, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) of the patients. When the perforated, non-perforated, and negative appendectomy groups were compared, the highest CRP level, NLR, and PLR were evident in the perforated appendectomy group (p = 0.001), whereas the lowest neutrophil percentage was found in the non-perforated appendectomy group (p = 0.001). Multiple logistic regression analysis identified neutrophil percentage, CRP value, and NLR as independent variables and demonstrated that AA could be diagnosed with 88.9 % accuracy using the cutoff values determined. In patients with suspected AA, particularly in rural areas with limited access to advanced imaging modalities, the evaluation of neutrophil percentage, CRP level, and NLR, in combination with the findings of a physical examination, may aid diagnosis and reduce NAR.
Acute appendicitis Negative appendectomy rate Neutrophil-to-lymphocyte ratio C-reactive protein Neutrophil percentage
This is a preview of subscription content, log in to check access
Each author’s contribution to the manuscript: conception and design: Fatih Mehmet Yazar and Murat Bakacak; data collection: Fatih Mehmet Yazar, Murat Bakacak, and Ömer Faruk Boran; writing the article: Fatih Mehmet Yazar and Aykut Urfalioğlu; and critical revision of the article: Ertan Bülbüloğlu.
Compliance with Ethical Standards
This manuscript has not been published elsewhere and is not under consideration by another journal.
In this article, there was no conflict with ethical standards as no data of human beings were created and approval for this study was obtained from the institutional Medical Ethics Committee.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Sandell E, Berg M, Sandblom G, Sundman J, Fränneby U, Boström L et al (2015) Surgical decision-making in acute appendicitis. BMC Surg 2:15–69Google Scholar
Inal M, Unal B, Bilgili YK (2014) Better visualization of vermiform appendix with tissue harmonic imaging compared to conventional sonography. Iran J Radiol 11(4):e18114CrossRefPubMedPubMedCentralGoogle Scholar
Bergeron E, Richer B, Gharib R, Giard A (1999) Appendicitis is a place for clinical judgement. Am J Surg 177:460–462CrossRefPubMedGoogle Scholar
Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ (2005) Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly. Am Surg 71(4):344–347PubMedGoogle Scholar
Tan WJ, Acharyya S, Goh YC, Chan WH, Wong WK, Ooi LL et al (2015) Prospective comparison of the Alvarado score and CT scan in the evaluation of suspected appendicitis: a proposed algorithm to guide CT use. J Am Coll Surg 220:218–224CrossRefPubMedGoogle Scholar
Toorenvliet BR, Wiersma F, Bakker RF, Merkus JW, Breslau PJ, Hamming JF (2010) Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis. World J Surg 34:2278–2285CrossRefPubMedPubMedCentralGoogle Scholar
Kahramanca S, Ozgehan G, Seker D, Gökce EI, Seker G, Tunç G et al (2014) Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg 20:19–22CrossRefPubMedGoogle Scholar
Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N (2014) Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol 33:223–227CrossRefPubMedGoogle Scholar
Salim DK, Mutlu H, Eryilmaz MK, Salim O, Musri FY, Tural D et al (2015) Neutrophil to lymphocyte ratio is an independent prognostic factor in patients with recurrent or metastatic head and neck squamous cell cancer. Mol Clin Oncol 3:839–842CrossRefPubMedPubMedCentralGoogle Scholar
Dirican A, Kucukzeybek BB, Alacacioglu A, Kucukzeybek Y, Erten C, Varol U et al (2015) Do the derived neutrophil to lymphocyte ratio and the neutrophil to lymphocyte ratio predict prognosis in breast cancer? Int J Clin Oncol 20:70–81CrossRefPubMedGoogle Scholar
Gurleyik E, Gurleyik G, Unalmiser S (1995) Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon’s clinical impression. Dis Colon Rectum 38:1270–1274Google Scholar
John SK, Joseph J, Shetty SR (2011) Avoiding negative appendectomies in rural surgical practice: is C-reactive protein estimation useful as a diagnostic tool? Natl Med J India 24:144–147PubMedGoogle Scholar
Paulson EK, Harris JP, Jaffe TA, Haugan PA, Nelson RC (2005) Acute appendicitis: added diagnostic value of coronal reformations from isotropic voxels at multi-detector row CT. Radiolog 235:879–885Google Scholar
Franca Neto AH, Amorim MM, Nóbrega BM (2015) Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras 61:170–177CrossRefPubMedGoogle Scholar
Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC (2013) Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 100:322–329CrossRefPubMedGoogle Scholar
Hallan S, Asberg A (1997) The accuracy of C-reactive protein in diagnosing acute appendicitis—a meta-analysis. Scand J Clin Lab Invest 57:373–380CrossRefPubMedGoogle Scholar
Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ (2006) Laboratory tests in patients with acute appendicitis. ANZ J Surg 76:71–74CrossRefPubMedGoogle Scholar
Bozkurt S, Kose A, Erdogan S, Bozali GI, Ayrik C, Arpaci RB et al (2015) MPV and other inflammatory markers in diagnosing acute appendicitis. J Pak Med Assoc 65:637–641PubMedGoogle Scholar
Şahbaz NA, Bat O, Kaya B, Ulukent SC, İlkgül Ö, Özgün MY et al (2014) The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis. Ulus Travma Acil Cerrahi Derg 20:423–426CrossRefPubMedGoogle Scholar
Anderson M, Anderson RE (2008) The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado Score. World J Surg 32:1843–1849CrossRefGoogle Scholar
Keskek M, Tez M, Yoldas O, Acar A, Akgul O, Gocmen E et al (2008) Receiver operating characteristic analysis of leukocyte counts in operations for suspected appendicitis. Am J Emerg Med 26:769–772CrossRefPubMedGoogle Scholar
Goodman DA, Goodman CB, Monk JS (1995) Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis. Am Surg 61:257–259PubMedGoogle Scholar
Shimizu T, Ishizuka M, Kubota K (2016) A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today Feb 46(1):84–89CrossRefGoogle Scholar
Ishizuka M, Shimizu T, Kubota K (2012) Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg 97:299–304CrossRefPubMedPubMedCentralGoogle Scholar
Borissoff JI, Spronk HM, ten Cate H (2011) The hemostatic system as a modulator of atherosclerosis. N Engl J Med 364:1746–1760CrossRefPubMedGoogle Scholar
Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A et al (2013) Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int 17:391–396CrossRefPubMedGoogle Scholar
Atan D, İkincioğulları A, Köseoğlu S, Özcan KM, Çetin MA, Ensari S et al (2015) New predictive parameters of Bell’s palsy: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. Balkan Med J 32:167–170CrossRefPubMedPubMedCentralGoogle Scholar
Özer S, Yılmaz R, Sönmezgöz E, Karaaslan E, Taşkın S, Bütün İ et al (2015) Simple markers for subclinical inflammation in patients with familial Mediterranean fever. Med Sci Monit 21:298–303CrossRefPubMedPubMedCentralGoogle Scholar
İlhan M, İlhan G, Gök AF, Bademler S, Verit Atmaca F, Ertekin C (2015) Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red blood cell distribution width-platelet ratio as early predictor of acute pancreatitis in pregnancy. J Matern Fetal Neonatal Med 29(9):1476–1480PubMedGoogle Scholar