Diagnostic Value of Neutrophil/lymphocyte ratio, C-reactive Protein and Alvarado Score in Patients With Acute Appendicitis
Öz
Objective: Acute appendicitis is not always easily diagnosed in emergency departments. The aim of this study was to investigate the effectiveness of Neutrophil/Lymphocyte Ratio (NLR), CRP and Alvarado score in diagnosing acute appendicitis in patients presenting to the emergency department with abdominal pain.
Method: This prospective study was collected on consecutive patients over a 6-month period. Patients who presented to the emergency department with abdominal pain and had not undergone appendectomy before were included in the study. The 296 patients included in the study were analyzed according to the last diagnosis and divided into 6 groups. In the light of the data obtained from the study, parameters such as CRP, left shift, NLO and Alvarado score were compared between these groups.
Results: The findings obtained in our study are as follows: (A) As a result of the analyses, the NLO, the rate of left shift in the smear and the Alvorado score were higher in the group with acute appendicitis compared to the group without acute appendicitis; (B) The rate of left shift and the Alvorado score were significantly higher in the group with histopathologically positive acute appendicitis compared to the negative group. (C) According to histopathologic examination of acute appendicitis, CRP value was significantly lower in cases diagnosed with early appendicitis, while it was significantly higher in cases of complicated appendicitis.
Conclusion: NLO, CRP and Alvarado score are useful in predicting acute appendicitis cases. However, the use of these parameters alone has limited ability to diagnose acute appendicitis.
Anahtar Kelimeler
Alvarado appendicitis Neutrophil/Lymphocyte Ratio C-reactive protein
Kaynakça
- 1. Moris D, Paulson EK, Pappas TN. Diagnosis and management of acute appendicitis in adults: a review. Jama 2021; 326(22):2299-2311.
- 2. Carr NJ. The pathology of acute appendicitis. Annals of diagnostic pathology 2000; 4(1):46–58.
- 3. Atema JJ, Gans SL, Beenen LF, Toorenvliet BR, Laurell H, Stoker J, Boermeester MA. Accuracy of White Blood Cell Countand C-reactive Protein Levels Related to Duration of Symptoms in Patients Suspected of Acute Appendicitis. Academic emergency medicine :official journal of the Society for Academic Emergency Medicine 2015; 22(9):1015–24.
- 4. Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. American journal of surgery 2020; 219(1): 154–63.
- 5. Bahta NNA, Rosenberg J, Fonnes S. Many diagnostic tools for appendicitis: a scoping review. Surgical Endoscopy 2023; 37(5):3419-29.
- 6. Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg 2010; 110:543-7.
- 7. Khan SA, Ashraf R, Hassaan N, Naseer M, Azad MH, Javed, H. The Role of Neutrophil-to-Lymphocyte Ratio in the Diagnosis of Acute Appendicitis. Cureus 2023; 15(12):e51164.
- 8. Akyuz M, Topal U, Öz B, İsaoğulları Ş, Sözüer E. Predictive value of neutrophil/lymphocyte ratios in the diagnosis of acute appendicitis. Bakırköy Tıp Dergisi 2020; 16(1):76-84.
- 9. Kahramanca Ş, Özgehan G, Şeker D, Gökce Eİ, Şeker G, Tunç G, Küçükpınar T, Kargıcı H. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Turkish Journal of Trauma and Emergency Surgery 2014; 20(1):19-22.
- 10. Dey S, Mohanta PK, Baruah AK, Kharga B, Bhutia KL, Singh VK. Alvarado scoring in acute appendicitis—a clinico-pathological correlati on. Indian J Surg 2010; 72 (4):290–93.
- 11. Alnjadat I, Abdallah B. Alvarado versus RİPASA score in diagnosing acute appendicitis. Rawal Medical Journal 2013; 38(2):147-51.
- 12. Thompson MM, Underwood MJ, Dookeran KA. Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. Bri J Surg 1992; 79:822-4.
- 13. Rosalki SB. C-reactive protein. Ġnt J Clin Pract 2001; 55(4):269-70.
- 14. Mengücük ME, Ayten R, Bülbüller N, Gödekmerdan A, Başbuğ M, Mungan İ. Akut apandisit tanısında serum C-reaktif protein, prokalsitonin ve neopterinin yeri. Fırat Tıp Dergisi 2010; 15(1):40-43.
- 15. Chen SC, Wang SM. C-reactive protein in the diagnosis of acute appendicitis. Am J Emerg Med 1996; 14:101-3.
- 16. Mustard RA, Bohnen JMA, Haseeb S, Kasina R. C-reactive protein levels predict postoperative septic complications. Arch Surg 1987; 122:69-73.
- 17. Oosterhuis WP, Zwinderman AH, Teeuwen M, van Andel G, Oldenziel H, Kerkhoff JF, Siebbeles HW, van der Helm HJ. C-reactive protein in the diagnosis of acute appendicitis. Eur J Surg 1993; 159:115-9.
- 18. Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med, 1999; 17: 1019-1025.
- 19. Oygür N, Arı E. (2007). Akut apendisit. Bilgel H (Ed.). Genel Cerrahi. İstanbul. Avrupa tıp kitapçılık ltd. şti. (s. 835-848).
Nötrofil/Lenfosit oranı, C- reaktif protein ve Alvarado Skorunun Akut Apandisit Düşünülen Hastalardaki Tanısal Değeri
Öz
Amaç: Akut apandisit’in acil servislere tanısı her zaman kolayca konulamamaktadır. Bu çalışmanın amacı acil servise karın ağrısı şikayeti ile başvuran hastalarda Nötrofil/ Lenfosit Oranı (NLO), CRP ve Alvarado skorunun akut apandisit tanısı koymadaki etkinliğini incelemektir.
Yöntem: Bu prospektif çalışma, 6 aylık süreç boyunca ardışık hastalar üzerinde toplanmıştır. Çalışmaya karın ağrısı şikayeti ile acil servise başvuran, daha önce apendektomi geçirmemiş, hastalar dahil edilmiştir. Çalışmaya dahil edilen 296 hasta son tanı yönüyle incelenerek 6 gruba ayrıldı. Çalışmadan elde edilen veriler ışığında bu gruplar arasında CRP, sola kayma ve NLO gibi parametreler ile Alvarado skorunun karşılaştırılması yapıldı.
Bulgular: Çalışmamızda elde edilen bulgular şu şekildedir: (A) Analizler sonucunda akut apandisit düşünülen grupta akut apandisit düşünülmeyen gruba göre daha yüksek NLO, yaymada sola kayma görülme oranı ve Alvorado skoru belirlenmiştir; (B) Akut apandisit histopatolojik olarak pozitif olan grupta negatif olan gruba göre sola kayma görülme oranı ve alvorado skoru anlamlı şekilde yüksek bulunmuştur. (C) akut apandisit histopatolojik incelenmesine göre, erken apandisit tanılı olgularda CRP değeri anlamlı şekilde düşükken, komplike olmuş apandisit olgularında anlamlı şekilde yüksektir.
Sonuç: Akut apandisit olgularını ön görmede NLO, CRP ve Alvarado skoru faydalıdır. Ancak bu parametrelerinin tek başına kullanılmaları akut apandisit tanısını koymada kısıtlı beceriye sahiptir.
Anahtar Kelimeler
Alvarado apandisit Nötrofil/ Lenfosit Oranı C-reaktif protein
Kaynakça
- 1. Moris D, Paulson EK, Pappas TN. Diagnosis and management of acute appendicitis in adults: a review. Jama 2021; 326(22):2299-2311.
- 2. Carr NJ. The pathology of acute appendicitis. Annals of diagnostic pathology 2000; 4(1):46–58.
- 3. Atema JJ, Gans SL, Beenen LF, Toorenvliet BR, Laurell H, Stoker J, Boermeester MA. Accuracy of White Blood Cell Countand C-reactive Protein Levels Related to Duration of Symptoms in Patients Suspected of Acute Appendicitis. Academic emergency medicine :official journal of the Society for Academic Emergency Medicine 2015; 22(9):1015–24.
- 4. Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. American journal of surgery 2020; 219(1): 154–63.
- 5. Bahta NNA, Rosenberg J, Fonnes S. Many diagnostic tools for appendicitis: a scoping review. Surgical Endoscopy 2023; 37(5):3419-29.
- 6. Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg 2010; 110:543-7.
- 7. Khan SA, Ashraf R, Hassaan N, Naseer M, Azad MH, Javed, H. The Role of Neutrophil-to-Lymphocyte Ratio in the Diagnosis of Acute Appendicitis. Cureus 2023; 15(12):e51164.
- 8. Akyuz M, Topal U, Öz B, İsaoğulları Ş, Sözüer E. Predictive value of neutrophil/lymphocyte ratios in the diagnosis of acute appendicitis. Bakırköy Tıp Dergisi 2020; 16(1):76-84.
- 9. Kahramanca Ş, Özgehan G, Şeker D, Gökce Eİ, Şeker G, Tunç G, Küçükpınar T, Kargıcı H. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Turkish Journal of Trauma and Emergency Surgery 2014; 20(1):19-22.
- 10. Dey S, Mohanta PK, Baruah AK, Kharga B, Bhutia KL, Singh VK. Alvarado scoring in acute appendicitis—a clinico-pathological correlati on. Indian J Surg 2010; 72 (4):290–93.
- 11. Alnjadat I, Abdallah B. Alvarado versus RİPASA score in diagnosing acute appendicitis. Rawal Medical Journal 2013; 38(2):147-51.
- 12. Thompson MM, Underwood MJ, Dookeran KA. Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. Bri J Surg 1992; 79:822-4.
- 13. Rosalki SB. C-reactive protein. Ġnt J Clin Pract 2001; 55(4):269-70.
- 14. Mengücük ME, Ayten R, Bülbüller N, Gödekmerdan A, Başbuğ M, Mungan İ. Akut apandisit tanısında serum C-reaktif protein, prokalsitonin ve neopterinin yeri. Fırat Tıp Dergisi 2010; 15(1):40-43.
- 15. Chen SC, Wang SM. C-reactive protein in the diagnosis of acute appendicitis. Am J Emerg Med 1996; 14:101-3.
- 16. Mustard RA, Bohnen JMA, Haseeb S, Kasina R. C-reactive protein levels predict postoperative septic complications. Arch Surg 1987; 122:69-73.
- 17. Oosterhuis WP, Zwinderman AH, Teeuwen M, van Andel G, Oldenziel H, Kerkhoff JF, Siebbeles HW, van der Helm HJ. C-reactive protein in the diagnosis of acute appendicitis. Eur J Surg 1993; 159:115-9.
- 18. Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med, 1999; 17: 1019-1025.
- 19. Oygür N, Arı E. (2007). Akut apendisit. Bilgel H (Ed.). Genel Cerrahi. İstanbul. Avrupa tıp kitapçılık ltd. şti. (s. 835-848).
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Genel Cerrahi, Acil Tıp |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 22 Mayıs 2025 |
| Yayımlanma Tarihi | 28 Mayıs 2025 |
| Gönderilme Tarihi | 4 Nisan 2024 |
| Kabul Tarihi | 7 Mayıs 2024 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 11 Sayı: 2 |
