Akut apandisitte negatif apendektominin öngörüsünde türetilmiş nötrofil/lenfosit oranı (dNLR)

Year 2026, Volume: 9 Issue: 2, 323 - 329, 12.03.2026

Zeki Öğüt , Onur Ağ , Bekir Sarıcık , Adem Tunçer , Nizamettin Kutluer , Ayşe Azak Bozan , Şeyma Kurtoğlu Özer , Tamer Gündoğdu , Mehmet Buğra Bozan

https://doi.org/10.32322/jhsm.1835033

https://izlik.org/JA76TK72XE

Abstract

Amaç: Bu çalışma, akut apandisit nedeniyle cerrahi uygulanan hastalarda preoperatif türetilmiş nötrofil-lenfosit oranı (derived neutrophil-to-lymphocyte ratio, dNLR) ile negatif apendektomi arasındaki ilişkiyi değerlendirmeyi amaçlamıştır. İkincil amaç ise, histopatolojiye dayalı gruplar arasındaki farklılıkları inceleyerek preoperatif dNLR’nin tanısal değerini araştırmaktır.
Yöntemler: Bu retrospektif gözlemsel çalışma, Ağustos 2018 ile Aralık 2024 tarihleri arasında hastanemizde akut apandisit ön tanısı ile apendektomi uygulanan 669 erişkin hastayı içermektedir. Histopatolojik sonuçlara göre hastalar negatif apendektomi ve pozitif apendektomi (komplike ve komplike olmayan) gruplarına ayrılmıştır. dNLR dâhil olmak üzere preoperatif tam kan sayımı parametreleri gruplar arasında karşılaştırılmıştır. dNLR’nin tanısal performansı, alıcı işletim karakteristiği (receiver operating characteristic, ROC) eğrisi analizi kullanılarak değerlendirilmiştir.
Bulgular: Negatif apendektomi oranı %20,3 olarak saptanmıştır. Negatif apendektomi grubunda dNLR, lökosit sayısı, nötrofil sayısı ve NLR anlamlı derecede daha düşüktü (p < 0,001). dNLR, negatif apendektomiden komplike olmayan apandisite ve ardından komplike apandisite doğru progresif bir artış göstermiştir. ROC analizi, dNLR’nin negatif apendektomiyi ayırt etmede orta düzeyde tanısal performansa sahip olduğunu göstermiştir; eğri altındaki alan (area under the receiver operating characteristic curve, AUC) 0,691 olup eşik değer ≥ 2,67 olarak belirlenmiştir. Komplike olguların alt grup analizinde, dNLR için AUC değeri 0,621 olarak bulunmuştur.
Sonuç: Bu çalışma, negatif apendektomi olgularında dNLR’nin anlamlı derecede daha düşük olduğunu ve hastalık şiddeti arttıkça yükseldiğini göstermiştir. Hem dNLR’nin hem de NLR’nin gruplar arasında ayırım yapabilme yeteneği, bu parametrelerin klinik karar verme sürecinde destekleyici biyobelirteçler olarak kullanılabileceğini düşündürmektedir. dNLR’nin tanısal doğruluğunu daha net ortaya koymak için prospektif, çok merkezli çalışmalara ihtiyaç vardır.

Keywords

Akut apandisit , Negatif apendektomi , Türetilmiş nötrofil-lenfosit oranı (dNLR) , Biyobelirteç

Ethical Statement

Bu çalışma, Elazığ Fethi Sekin Şehir Hastanesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Tarih: 16 Ekim 2025; Karar No: 2025/17-10). Çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüş olup hasta kimlik bilgilerinin gizliliği korunmuştur.

Supporting Institution

Yoktur.

Project Number

Not applicable

Thanks

Yoktur.

Derived neutrophil-to-lymphocyte ratio as a predictor of negative appendectomy in acute appendicitis

https://izlik.org/JA76TK72XE

Abstract

Aims: This study aimed to evaluate the association between preoperative derived neutrophil-to-lymphocyte ratio (dNLR) and negative appendectomy in patients undergoing surgery for acute appendicitis. The secondary aim was to investigate the diagnostic value of preoperative dNLR by examining its differences across the histopathology-based groups.
Methods: This retrospective observational study included 669 adult patients who underwent appendectomy for a preoperative diagnosis of acute appendicitis between August 2018 and December 2023 at our hospital. Based on the histopathological results, the patients were categorized into negative appendectomy and positive appendectomy (complicated and uncomplicated) groups. Preoperative complete blood count parameters, including dNLR, were compared between the groups. The diagnostic performance of dNLR was assessed using receiver operating characteristic (ROC) curve analysis.
Results: The rate of negative appendectomy was 20.3%. The negative appendectomy group had a significantly lower dNLR, leukocyte count, neutrophil count, and NLR (p<0.001). The dNLR increased progressively from negative appendectomy to uncomplicated appendicitis and further to complicated appendicitis. ROC analysis demonstrated that dNLR had moderate diagnostic performance in distinguishing negative appendectomy, with an area under the ROC curve (AUC) of 0.691 and a cut off value ≥2.67. In the subgroup analysis of complicated cases, the AUC for dNLR was 0.621.
Conclusion: This study demonstrated that dNLR was significantly lower in negative appendectomy cases and increased with disease severity. The ability of both dNLR and NLR to differentiate between groups suggests that they may serve as supportive biomarkers in clinical decision-making. Prospective multicenter studies are warranted to further clarify the diagnostic accuracy of the dNLR.

Keywords

Acute appendicitis , biomarker , derived neutrophil-lymphocyte ratio , negative appendectomy

Ethical Statement

This study was approved by the Elazığ Fethi Sekin City Hospital Non-Interventional Clinical Research Ethics Committee (Date: 16 October 2025; Decision No: 2025/17-10). The study complied with the principles of the Declaration of Helsinki. No personal identifiers were collected, and patient confidentiality was strictly maintained.

Supporting Institution

None.

Project Number

Not applicable

Thanks

None.

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