Neutrophil-to-lymphocyte ratio as a predictor of postoperative complications and readmissions after appendectomy in children.
Acute appendicitis
Children
Neutrophil-to-lymphocyte ratio
Risk factor
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
02
11
2022
accepted:
28
08
2023
pubmed:
3
9
2023
medline:
3
9
2023
entrez:
2
9
2023
Statut:
ppublish
Résumé
To analyze the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the development of postoperative complications and readmission after appendectomy in children. A retrospective single-centered case-control study was conducted on children who underwent appendectomy between 2017 and 2020. Demographics, time since symptoms onset, laboratory tests at admission, postoperative complications, and readmissions in the first 30 days after surgery were recorded. Sensitivity and specificity analysis of the parameters evaluated were determined by the area under the curve (AUC) represented on the receiver operating characteristic (ROC) curves. A total of 1,214 patients (765 males; 449 females) were included, with a median age at diagnosis of 10.4 years. The median time from symptom onset was 24 h. During the first 30 days after surgery, 149 postoperative complications were reported (12.3%). NLR at admission presented the highest AUC (0.753), with a cut-off point of 10.5 for maximum sensitivity (68.7%) and specificity (86.1%). Readmissions were reported in 45 cases (3.7%). NLR at admission presented an AUC of 0.794 significantly higher than neutrophils (0.696), leukocytes (0.654), and time since symptom onset (0.622), making these differences statistically significant (p < 0.001). The cut-off point of NLR > 12.4 was estimated, with a maximum sensitivity and specificity of 71.0% and 82.3% for predicting readmission. NLR is an independent predictor of postoperative complications and readmission in children with acute appendicitis. While its application in routine clinical practice has yet to be established, the NLR may provide clinicians with a tool for identifying high-risk surgical patients.
Identifiants
pubmed: 37659982
doi: 10.1007/s13304-023-01639-9
pii: 10.1007/s13304-023-01639-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2273-2278Informations de copyright
© 2023. Italian Society of Surgery (SIC).
Références
Beliaev AM, Angelo N, Booth M et al (2016) Evaluation of neutrophil-to-lymphocyte ratio as a potential biomarker for acute cholecystitis. J Surg Res 209:93–101
doi: 10.1016/j.jss.2016.09.034
pubmed: 28032577
Zhang Y, Wu W, Dong L et al (2016) Neutrophil to lymphocyte ratio predicts persistent organ failure and in-hospital mortality in an Asian Chinese population of acute pancreatitis. Medicine (Baltimore) 95:e4746
doi: 10.1097/MD.0000000000004746
pubmed: 27631223
Acarturk G, Acay A, Demir K, Ulu MS, Ahsen A, Yuksel S (2015) Neutrophil-to-lymphocyte ratio in inflammatory bowel disease - as a new predictor of disease severity. Bratisl Lek Listy 116:213–217
pubmed: 25773946
Delgado-Miguel C, García A, Delgado B, Muñoz Serrano AJ, Miguel Ferrero M, Camps J et al (2022) Neutrophil-to-lymphocyte ratio as a predictor of the need for surgical treatment in children´s intussusception. Eur J Pediatr Surg. https://doi.org/10.1055/a-1913-4280
doi: 10.1055/a-1913-4280
pubmed: 35913089
Reyes-Gálvez JA, Gracida-Mancilla NI, Enríquez-Santos D et al (2016) Neutrophil-lymphocyte ratio as predictor of severity and mortality in patients with abdominal sepsis. Med Int Mex 32:41–47
Goodman DA, Goodman CB, Monk JS (1995) Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis. Am Surg 61:257–259
pubmed: 7887542
Jung SK, Rhee DY, Lee WJ et al (2017) Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department. Aging Clin Exp Res 29:529–536
doi: 10.1007/s40520-016-0584-8
pubmed: 27216860
Ishizuka M, Shimizu T, Kubota K (2012) Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg 97:299–304
doi: 10.9738/CC161.1
pubmed: 23294069
pmcid: 3727267
Shimizu T, Ishizuka M, Kubota K (2016) A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today 46:84–89
doi: 10.1007/s00595-015-1125-3
pubmed: 25686778
Delgado-Miguel C, Muñoz-Serrano AJ, Barrena S et al (2019) Neutrophil-to-lymphocyte ratio as a predictor of peritonitis in acute appendicitis in children. Cir Pediatr 32:185–189
pubmed: 31626403
Delgado-Miguel C, Muñoz-Serrano AJ, Núñez V et al (2019) Neutrophil-to-lymphocyte ratio as a predictor of postsurgical intraabdominal abscess in children operated for acute appendicitis. Front Pediatr 7:424
doi: 10.3389/fped.2019.00424
pubmed: 31750277
pmcid: 6842996
Celik B, Nalcacioglu H, Ozcatal M et al (2019) Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg 25:222–228
pubmed: 31135939
Yazic M, Ozkisacik S, Oztan M, Gürsoy H (2010) Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 52:400–403
Buicko JL, Parreco J, Abel SN et al (2017) Pediatric laparoscopic appendectomy, risk factors, and costs associated with nationwide readmissions. J Surg Res 215:245–249
doi: 10.1016/j.jss.2017.04.005
pubmed: 28688655
Li K, Peng YG, Yan RH et al (2020) Age-dependent changes of total and differential white blood cell counts in children. Chin Med J (Engl) 133:1900–1907
doi: 10.1097/CM9.0000000000000854
pubmed: 32826452
CDC/NHSN Procedure-associated Module (2021) Surgical Site Infection (SSI) Event at: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf . Accessed 25 April 2021
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Fluss R, Faraggi D, Reiser B (2005) Estimation of the Youden Index and its associated cutoff point. Biom J 47:458–472
doi: 10.1002/bimj.200410135
pubmed: 16161804
DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845
doi: 10.2307/2531595
pubmed: 3203132
Josse JM, Cleghorn MC, Ramji KM et al (2016) The neutrophil-to-lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery. Colorectal Dis 18:O236–O242
doi: 10.1111/codi.13373
pubmed: 27154050
Da Silva M, Cleghorn MC, Elnahas A et al (2017) Postoperative day one neutrophil-to-lymphocyte ratio as a predictor of 30-day outcomes in bariatric surgery patients. Surg Endosc 31:2645–2650
doi: 10.1007/s00464-016-5278-y
pubmed: 27743125
Nguyen JMV, Ferguson SE, Bernardini MQ et al (2020) Preoperative neutrophil-to-lymphocyte ratio predicts 30 day postoperative morbidity and survival after primary surgery for ovarian cancer. Int J Gynecol Cancer 30:1378–1383
doi: 10.1136/ijgc-2020-001378
pubmed: 32788264
Tan TP, Arekapudi A, Metha J et al (2015) Neutrophil-lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: a systematic review. ANZ J Surg 85:414–419
doi: 10.1111/ans.13036
pubmed: 25781147
Barker T, Rogers VE, Henriksen VT et al (2016) Is there a link between the neutrophil-to-lymphocyte ratio and venous thromboembolic events after knee arthroplasty? A pilot study. J Orthop Traumatol 17:163–168
doi: 10.1007/s10195-015-0378-3
pubmed: 26387114
Segel GB, Halterman MW, Lichtman MA (2011) The paradox of the neutrophil’s role in tissue injury. J Leukoc Biol 89:359–372
doi: 10.1189/jlb.0910538
pubmed: 21097697
Zahorec R (2001) Ratio of neutrophil to lymphocyte counts: rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 102:5–14
pubmed: 11723675
Mears AL, Bisharat M, Murphy F, Sinha CK (2019) Readmission within 30 days of discharge (ReAd): a quality-of-care indicator in paediatric surgery. Pediatr Surg Int 35:597–602
doi: 10.1007/s00383-019-04449-6
pubmed: 30778702
Rice-Townsend S, Hall M, Barnes JN et al (2012) Hospital readmission after management of appendicitis at freestanding children’s hospitals: contemporary trends and financial implications. J Pediatr Surg 47:1170–1176
doi: 10.1016/j.jpedsurg.2012.03.025
pubmed: 22703789
Short HL, Sarda S, Heiss K et al (2016) Return to the system within 30 days of discharge after pediatric appendectomy. Am Surg 82:626–631
doi: 10.1177/000313481608200729
pubmed: 27457862
Bardach N, Vittinghoff E, Asteria-Penaloza R et al (2013) Measuring hospital quality using pediatric readmission and revisit rates. Pediatrics 132:426–429
doi: 10.1542/peds.2012-3527
Berry J, Toomey S, Zaslavsky A et al (2013) Pediatric readmissions and variability across hospitals. JAMA 309:372–380
doi: 10.1001/jama.2012.188351
pubmed: 23340639
pmcid: 3640861
Nelson DS, Bateman B, Bolte RG (2000) Appendiceal perforation in children diagnosed in a pediatric emergency department. Pediatr Emerg Care 16:233–237
doi: 10.1097/00006565-200008000-00004
pubmed: 10966339
Zouari M, Abid I, Sallami S et al (2017) Predictive factors of complicated appendicitis in children. Am J Emerg Med 35:1982–1983
doi: 10.1016/j.ajem.2017.06.049
pubmed: 28668176
Narsule CK, Kahle EJ, Kim DS et al (2011) Effect of delay in presentation on rate of perforation in children with appendicitis. Am J Emerg Med 29:890–893
doi: 10.1016/j.ajem.2010.04.005
pubmed: 20627213
Morse RB, Hall M, Fieldston ES et al (2013) Children’s hospitals with shorter lengths of stay do not have higher readmission rates. J Pediatr 163:1034–8.e1
doi: 10.1016/j.jpeds.2013.03.083
pubmed: 23683748
Delgado-Miguel C, Muñoz-Serrano AJ, Moratilla L et al (2023) Neutrophil-to-lymphocyte ratio as a predictor of surgical site infection in acute appendicitis. Transl Pediatr 12:552–559
doi: 10.21037/tp-22-360
pubmed: 37181027
pmcid: 10167395
Jen HC, Shew SB (2010) Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis. J Surg Res 161:13–17
doi: 10.1016/j.jss.2009.06.033
pubmed: 20031168
Johansen LS, Thorup JM, Rasmussen L, Hussain ZB, Kehlet H (2011) Prolonged length of stay and many readmissions after appendectomy. Dan Med Bull 58:A4296
pubmed: 21722542