The Role of Lymphocyte-to-Monocyte Ratio Levels in Diagnosis of Appendicitis in Children

Yıl 2024, Cilt: 10 Sayı: 3, 457 - 461, 19.09.2024

Kutay Bahadır , Ufuk Ateş , Ergun Ergün , Pari Khalilova , Meltem Koloğlu , Ahmet Çakmak , Gülnur Göllü Bahadır

https://doi.org/10.53394/akd.1328482

Öz

Objective: Appendicitis is the most common surgical disease with right lower abdominal pain in pediatric age. This study aimed to investigate the diagnostic value of lymphocyte monocyte ratio (LMR) in appendicitis in children.
Methods: A total of 150 patients under the age of 18 who were admitted hospital and given blood samples due to reasons of non-inflammatory conditions and were proved to have appendicitis (non-complicated or complicated) between 2017-2020 were analyzed retrospectively. Patients were classified into three subgroups: Group 1 (healthy children without any inflammation, n=50), Group 2 (non-complicated appendicitis, n=50) and Group 3 (complicated appendicitis, n=50).
Results: The median LMR level was significantly lower in the non-complicated and complicated appendicitis groups than in group 1 (p=0,000). The cut-off value of LMR on admission to predict non-complicated appendicitis was 2,98 with a sensitivity of 94% and a specificity of 96% (area under the curve, 0,960, p= 0,000). The cut-off value of LMR on admission to predict complicated appendicitis was 2,15 with a sensitivity of 96% and a specificity of 72% (area under the curve, 0,865, p= 0,000).
Conclusion: This study shows that LMR ratio may be helpful with high sensitivity and specificity in diagnosing appendicitis.

Anahtar Kelimeler

Appendicitis, Children, inflammation, lymphocyte monocytes ratio

Çocuklarda Apendisit Tanısında Lenfosit Monosit Oranı Değerinin Rolü

Öz

Amaç: Apendisit, çocuk yaş grubunda sağ alt kadran ağrısının en sık cerrahi hastalığıdır. Bu çalışmanın amacı, çocuklarda apendisitte lenfosit monosit oranının(LMO) tanısal değerini araştırmaktır.
Yöntemler: 2017-2020 yılları arasında 18 yaşından küçük inflamatuar olmayan nedenlerle hastaneye başvurup kanları alınan ve apendisit (komplike olmayan veya komplike olmayan) tanısı almış toplam 150 hasta retrospektif olarak incelendi. Hastalar Grup 1 (inflamasyonu olmayan sağlıklı çocuklar, n=50), Grup 2 (komplike olmayan apendisit, n=50) ve Grup 3 (komplike apendisit, n=50) olmak üzere üç alt gruba ayrıldı.
Bulgular: Ortalama LMO düzeyinin komplike olmayan ve komplike apendisit gruplarında grup 1'e göre anlamlı olarak düşük olduğu görüldü(p=0,000). LMO'nun komplike olmayan apandisiti öngörmek için başvurudaki cut-off değeri 2,98'dir, duyarlılığı %94 ve özgüllüğü %96'dır (eğrinin altındaki alan, 0,960, p= 0,000). LMR'nin başvuruda komplike apandisiti öngörmek için cut-off değeri 2,15, duyarlılığı %96 ve özgüllüğü %72 idi (eğri altındaki alan, 0,865, p= 0,000).
Sonuç: Bu çalışma, LMO oranının yüksek duyarlılık ve özgüllük ile apandisit tanısının koyulmasında yardımcı olabileceğini göstermektedir.

Anahtar Kelimeler

Apandisit, Çocuk, inflamasyon, lenfosit monosit oranı

Kaynakça

• 1. Özdamar MY, Karavaş E. Acute mesenteric lymphadenitis in children: findings related to differential diagnosis and hospitalization. Arch Med Sci 2020; 16(2):313–20.
• 2. Tuncer AA, Cavus S, Balcioglu A, Silay S, Demiralp İ, Calkan E, Altin MA, Eryilmaz E, Karaisaoglu AO, Bükülmez A, Dogan İ, Embleton DB, Cetinkursun S. Can mean platelet volume, Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, Platelet-to-Lymphocyte ratios be favourable predictors for the differential diagnosis of appendicitis? J Pak Med Assoc 2019; 69(5):647–54.
• 3. Ates U, Bahadir K, Ergun E, Gollu G, Durmaz M, Gunay F, Erguder I, Bingol-Kologlu M, Yagmurlu A, Dindar H, Cakmak M. Determination of Pentraxin 3 levels in diagnosis of Appendicitis in children. Pediatr Int 2020; 62(5):624-8.
• 4. Çağlayan F, Çakmak M, Çağlayan O, Çavuşogˇlu T. Plasma D -Lactate Levels in Diagnosis of Appendicitis. J Investig Surg 2003; 16(4):233–7.
• 5. Glass CC, Rangel SJ. Overview and diagnosis of acute appendicitis in children. Semin Pediatr Surg 2016; 25(4):198–203.
• 6. Salö M, Roth B, Stenström P, Arnbjörnsson E, Ohlsson B. Urinary biomarkers in pediatric appendicitis. Pediatr Surg Int 2016; 32(8):795–804.
• 7. Moosmann J, Krusemark A, Dittrich S, Ammer T, Rauh M, Woelfle J, Metzler M, Zierk J. Age‐ and sex‐specific pediatric reference intervals for neutrophil‐to‐lymphocyte ratio, lymphocyte‐to‐monocyte ratio, and platelet‐to‐lymphocyte ratio. Int J Lab Hematol 2022; 44(2):296–301.
• 8. Okba AM, Amin MM, Abdelmoaty AS, Ebada HE, Kamel A, Allam A, Sobhy O. Neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio in ulcerative colitis as non-invasive biomarkers of disease activity and severity. Autoimmun Highlights 2019; 10(1):4.
• 9. Kaiser M, Schroeckenfuchs M, Castellani C, Warncke G, Till H, Singer G. The diagnostic value of hepcidin to predict the presence and severity of appendicitis in children. J Surg Res. 2018; 222:102-7.
• 10. Huckins DS, Simon HK, Copeland K, Spiro DM, Gogain J, Wandell M. A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain. Am J Emerg Med 2013; 31(9):1368–75.
• 11. Lee SK, Lee SC, Park JW, Kim S-J. The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study. BMC Surg 2014; 14(1):100.
• 12. Wither AS, Grieve A, Loveland JA. Correlation of white cell count and CRP in acute appendicitis in paediatric patients. S Afr J Surg 2019; 57(4):40.
• 13. Shafi S, Afsheen M, Reshi F. Total leucocyte count, C-reactive protein and neutrophil count: Diagnostic Aid in acute appendicitis. Saudi J Gastroenterol 2009; 15(2):117.
• 14. Oztan MO, Aksoy Gokmen A, Ozdemir T, Müderris T, Kaya S, Koyluoglu G. Pentraxin-3: A strong novel biochemical marker for appendicitis in children. Am J Emerg Med 2019; 37(10):1912–6.
• 15. 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(5):543–7.
• 16. Yazici M, Ozkisacik S, Oztan MO, Gürsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010; 52(4):400–3.
• 17. Lu C, Zhou L, Ouyang J, Yang H. Prognostic value of lymphocyte-to-monocyte ratio in ovarian cancer. Medicine (Baltimore) 2019; 98(24):e15876.
• 18. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, Babyn PS, Dick PT. US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology 2006; 241(1):83–94.
• 19. Çetinkaya E, Erdoğan A, Akgül Ö, Çelik C, Tez M. High serum cancer antigen 125 level indicates perforation in acute appendicitis. Am J Emerg Med 2015; 33(10):1465–7.