Comparison of the use of neutrophil: lymphocyte count ratio (NLCR) to total leukocyte count in diagnosing appendicitis in adults

Abstract

Introduction: Appendectomy is the most commonly performed emergency operation in the world. The life time risk of undergoing appendectomy is around 8% and maximal incidence occurs in the second and third decade of life. Diagnosis of acute appendicitis (AA) is purely based on history, examination and few laboratory investigations. However, it is often a perplexing diagnostic problem during the early stages of the disease. Failure to make an early diagnosis is a primary reason for morbidity and mortality. Leukocytosis is being used commonly to diagnose acute appendicitis. Recently, it has been proposed that netrophil: lymphocyte count ratio (NLCR) is a more sensitive marker than leukocytosis in patients with acute appendicitis.Method: This is a prospective study conducted over a period of one year in the department of surgery, Tribhuvan University Teaching Hospital TUTH from September 2013 to August 2014.Total 106 patients were  included in the study. AA was diagnosed by clinical and laboratory parameters. TLC and NLCR of patients diagnosed as AA was recorded in the proforma. Histological diagnosis was taken as the final diagnosis. SPSS software was used for analysis of data.Results: Male: Female ratio was 2.02:1, with mean age of 29.63 years .Right iliac fossa tenderness was the most common sign  and an average leukocyte count of 12534/ul. All cases diagnosed clinically as acute appendicitis were confirmed histopathologically. NLCR> 3.5 was observed on 90.56% of patient whereas 78.3% of patients had leukocytosis which was statistically significant (p= 0.0001).Conclusion: NLCR is a more sensitive laboratory parameter than TLC  in patients with acute appendicitis.