Diagnostic Performance of Platelet-to-Lymphocyte Ratio in Predicting Complicated Acute Appendicitis: A Comparative Analysis with Other Inflammatory Markers

Öz

Background Acute appendicitis is one of the most common surgical emergencies encountered in clinical practice. Complicated appendicitis may result in perforation, abscess formation, and increased morbidity. This study aimed to evaluate the diagnostic value of the platelet-to-lymphocyte ratio (PLR) in differentiating complicated from simple acute appendicitis and to compare its performance with other inflammatory markers. Methods In this retrospective study, 261 histopathologically confirmed acute appendicitis patients were included. Patients were classified as simple suppurative (n=187) or complicated (n=74) based on pathological findings. Laboratory parameters were compared using the Mann–Whitney U test. The discriminative ability of inflammatory markers was assessed using receiver operating characteristic (ROC) curve analysis, and the area under the curve (AUC) with 95% confidence intervals was calculated to quantify overall discriminatory performance. Univariate and multivariate logistic regression analyses were performed to determine independent predictors of complicated appendicitis. Results WBC, CRP, and NLR levels were significantly higher in the complicated appendicitis group (p<0.05). Although PLR values tended to be higher in complicated cases, the difference did not reach statistical significance (p=0.054). In ROC analysis, WBC (AUC=0.621), CRP (AUC=0.623), and NLR (AUC=0.617) showed comparable discriminative performance, whereas PLR demonstrated limited and non-significant predictive ability (AUC=0.576, p=0.054). In multivariate analysis, NLR and CRP remained independent predictors, while PLR was not confirmed as an independent predictor. The highest discriminative performance was observed in the combined Age+WBC+CRP model (AUC=0.694). Conclusion PLR did not demonstrate statistically significant independent predictive value for complicated acute appendicitis, whereas NLR and CRP showed modest but more consistent discriminative performance. Routine inflammatory markers may assist in early risk stratification; however, they should not be used as standalone decision-making tools.

Anahtar Kelimeler

• acute appendicitis
• biomarkers
• neutrophile count
• lymphocyte count
• c-reactive protein

Komplike Akut Apandisitin Öngörülmesinde Trombosit/Lenfosit Oranının Tanısal Performansı: Diğer İnflamatuvar Belirteçlerle Karşılaştırmalı Analiz

Öz

Amaç: Akut apandisit, klinik pratikte en sık karşılaşılan cerrahi acillerden biridir. Komplike apandisit perforasyon, apse gelişimi ve artmış morbidite ile ilişkilidir. Bu çalışmada, trombosit/lenfosit oranının (PLR) komplike ve basit akut apandisiti ayırt etmedeki tanısal değeri değerlendirilmiş ve diğer inflamatuvar belirteçlerle karşılaştırılmıştır. Yöntem: Bu retrospektif çalışmaya histopatolojik olarak doğrulanmış 261 akut apandisit hastası dahil edildi. Hastalar patolojik bulgulara göre basit süpüratif (n=187) ve komplike (n=74) olarak iki gruba ayrıldı. Laboratuvar parametreleri Mann–Whitney U testi ile karşılaştırıldı. İnflamatuvar belirteçlerin ayırt edici performansı ROC eğrisi analizi ile değerlendirildi ve eğri altındaki alan (AUC) %95 güven aralığı ile hesaplandı. Komplike apandisitin bağımsız belirleyicilerini saptamak amacıyla tek değişkenli ve çok değişkenli lojistik regresyon analizleri yapıldı. Bulgular: Komplike apandisit grubunda WBC, CRP ve NLR düzeyleri anlamlı olarak daha yüksekti (p<0.05). PLR değerleri komplike olgularda daha yüksek olma eğiliminde olmakla birlikte istatistiksel anlamlılığa ulaşmadı (p=0.054). ROC analizinde WBC (AUC=0.621), CRP (AUC=0.623) ve NLR (AUC=0.617) benzer ayırt edici performans gösterirken, PLR’nin prediktif gücü sınırlı ve istatistiksel olarak anlamlı değildi (AUC=0.576, p=0.054). Çok değişkenli analizde NLR ve CRP bağımsız prediktör olarak kalırken, PLR bağımsız bir belirleyici olarak doğrulanmadı. En yüksek ayırt edici performans Yaş+WBC+CRP kombinasyon modelinde elde edildi (AUC=0.694). Sonuç: PLR, komplike akut apandisiti öngörmede istatistiksel olarak anlamlı ve bağımsız bir prediktif değer göstermemiştir. Buna karşılık NLR ve CRP daha tutarlı ancak orta düzeyde ayırt edici performans sergilemiştir. Rutin inflamatuvar belirteçler erken risk sınıflamasında yardımcı olabilir; ancak tek başına karar verme aracı olarak kullanılmamalıdır.

Anahtar Kelimeler

• akut apandisit
• biyobelirteçler
• nötrofil sayısı
• lenfosit sayısı
• c-reaktif protein

Kaynakça

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