Acute appendicitis (AA) is the most common acute surgical disease worldwide. Despite the use of preoperative advanced radiological instruments, preoperative determination of complicated cases is still difficult and remains an important concern. The aim of this study is to evaluate the predictive value of the platelet-to-lymphocyte ratio and of the presence of elevated white blood cells to discriminate between complicated and uncomplicated AA.
All patients who were admitted to the emergency care unit and underwent urgent laparotomy for AA were analyzed retrospectively. The platelet-to-lymphocyte ratio and white blood cell count were measured. Patients were divided into two groups: uncomplicated cases (group 1) and complicated cases (group 2). White blood cell count and platelet-to-lymphocyte ratio were compared between the two groups.
There were 196 patients in group 1 and 43 patients in group 2. The gender distribution between groups was homogeneous (p=0.020); the mean age of group 2 was higher than group 1 (p<0.001). The platelet-to-lymphocyte ratio was significantly higher in group 2; there was also a significant difference in the white blood cell count (p<0.001 and p=0.029 respectively). The platelet-to-lymphocyte ratio was significantly higher in group 2, and was predictive of complications independently of age and gender (p<0.001). The cutoff value of the platelet-to-lymphocyte ratio was 169.7, giving a sensitivity of 74.4% and specificity of 73.5%.
The platelet-to-lymphocyte ratio could predict complicated cases with a higher sensitivity and specifity than white blood cell count.
Keywords: Acute appendicitis, perforated appendicitis, platelets, lymphocytes, white blood cells.